A Guide to Medicare Advantage HMO-POS Plans

Health Line

a day ago

Medicare Advantage offers various plan types to choose from. One such option is the Health Maintenance Organization Point-of-Service (HMO-POS) plan. This type of plan is similar to an HMO plan but offers different costs and benefits.
Medicare Advantage plans are an alternative to Original Medicare (parts A and B). While each Medicare Advantage plan is required to offer the same coverage as Original Medicare, they may also offer other benefits. These additional benefits may include vision, dental, and hearing, among others.
There are six options for Medicare Advantage plans:
Health Maintenance Organization (HMO)
Health Maintenance Organization Point-of-Service (HMO-POS)
Preferred Provider Organization (PPO)
Medicare medical savings account (MSA)
Private Fee-For-Service (PFFS)
Special Needs Plan (SNP)
Glossary of common Medicare terms
Out-of-pocket cost: This is the amount you pay for care when Medicare doesn't pay the full cost or offer coverage. It includes premiums, deductibles, coinsurance, and copayments.
Premium: This is the monthly amount you pay for Medicare coverage.
Deductible: This is the annual amount you must spend out of pocket before Medicare begins to cover services and treatments.
Coinsurance: This is the percentage of treatment costs you're responsible for paying out of pocket. With Medicare Part B, you typically pay 20%.
Copayment: This is a fixed dollar amount you pay when receiving certain treatments or services. With Medicare, this often applies to prescription medications.
What does HMO-POS mean?
An HMO-POS plan is an HMO plan that offers point-of-service payments in certain circumstances.
This means that HMO-POS plans work in basically the same way that HMO plans do.
For example, you still have to choose a primary care physician (PCP) and use in-network providers most of the time. But in certain situations, you can go outside of the network for care and pay a higher copayment or coinsurance.
This is similar to a PPO plan but may cost less.
»Learn more: Medicare Advantage HMO plans
How do HMO-POS plans work?
Generally, HMO-POS plans work the same way regular HMO plans do:
You typically must choose a PCP.
You typically have to use healthcare providers within your plan's network.
You typically must have a referral to see a specialist.
HMO-POS plans tend to offer a bit more flexibility. They allow you to get some services using out-of-network providers for a higher cost. This allows you similar flexibility to PPO plans at a lower cost.
Vs. PPO plans
PPO plans offer more flexibility than HMO-POS plans. With PPO plans:
You have a list of in-network providers. But you can also see out-of-network providers at a higher cost.
You do not have to choose a PCP.
You do not need a referral to see a specialist.
Summary
HMO-POS plans generally work the same way HMO plans do. But they offer some of the flexibility of PPO plans as well.
This means, in some circumstances, you can see out-of-network providers. You'll have to pay more for these services. But you have the option to use them if you need them without changing plans.
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