Medicare HMO Point-of-Service Option Plans

While shopping for health insurance coverage, you may notice different types of plans such as HMO, PPO, POS, or HMO-POS plans. All of these acronyms describe the different types of Medicare Advantage health insurance plans available to seniors. Medicare HMO Point-of-Service Option plans can deliver more options and flexibility to seniors.

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Health Management Organization (HMO) plans, Preferred Provider Organization (PPO) plans and Point-of-Service (POS) plans, and Health Management Organization with a Point-of-Service Option (HMO-PPO) plans each provide different types of coverage and benefits to seniors.

HMOs and PPOs are the most popular, while POS plans remain less familiar. However, it’s important to note that a POS plan is a mix of HMO benefits and PPO benefits.

Like PPOs, Medicare Advantage HMO that offers a point-of-service option, allows members to freely visit doctors outside of the plan’s network of providers. This includes specialists, but the out-of-pocket costs will be higher. Like HMOs, seniors may need to choose a primary care physician to help coordinate care and provide referrals for specialists.

What Is an HMO-POS Medicare Advantage Plan?

Medicare HMO Point-of-Service Option plans are Health Maintenance Organizations (HMOs) that offer added point-of-service (POS) benefits. You will have more flexibility when it comes to receiving care with these added benefits. Medicare Advantage HMO Point-of-Service Option benefits allow you to choose from a network of doctors and hospitals under the plan.

It’s important to note, however, that beneficiaries must follow the rules and guidelines of their plan before receiving medical care. For example, you may need prior approval in order to receive your benefits. When using POS plans, you’ll need a referral from your primary doctor before seeing a specialist for healthcare.

Original Medicare (Part A and Part B) provides necessary health care coverage, but it doesn’t provide coverage for all services.

Also known as Medicare Part C, Advantage plans can cover services that Original Medicare does not. The level of benefits depends on the type of plan. The most popular types are HMOs and PPOs.

Fewer people enroll in POS plans; about 9% of enrollees choose this plan type. For members looking to avoid high healthcare expenses, Advantage plans may be a good option.

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All Medicare Advantage plan types wrap Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), such as outpatient services or doctors’ visits, into one plan. Most plans include Medicare Part D (prescription drug coverage), so there’s no need to purchase a stand-alone plan.

A Medicare Advantage HMO plan with a POS option offers coverage for members that travel a lot within the country, different from the location restrictions of HMO plans. Although, members should expect a higher cost when using the point-of-service option (out-of-network providers).


Medicare Advantage plans with an HMO-POS include the convenience of having one doctor to coordinate all healthcare needs. Additionally, Medicare HMO-POS plans are great for seniors traveling throughout the United States. Here’s an example of how they work:

John lives in New Mexico, where he has HMO Point-of-Service Option coverage. He’s planning a trip to stay with his family in Arizona for 2 months and has several health concerns. John wants to make sure he can visit a doctor while he’s away from home.

Before leaving, John works with his primary care physician to find an in-network provider in the location he’s visiting. This doctor will act as John’s PCP until he returns to New Mexico.

Contrarily, Medicare PPO plans offer more flexibility than HMOs, including HMO-POS policies. For starters, beneficiaries don’t need to choose one primary care physician to coordinate care. Unlike HMOs, PPOs don’t require referrals to visit with a specialist.

Both Medicare Advantage HMO/POS plans and PPO plans allow members to visit with providers inside or outside of the plan’s network. Costs are less when staying inside a plan’s network but higher when receiving services from an out-of-network physician.

If John needs to see a dermatologist while on his trip after discovering some concerning skin spots, he can do just that. His Medicare Advantage HMO-POS plan allows him to make an appointment without visiting his primary care doctor for a referral.

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Medicare Part D and HMO-POS Plans

Prescription drug coverage can be costly, but seniors have options. Medicare Part D prescription drug plans can help with this expense.

In most cases, HMO-POS plans pay for prescriptions. However, seniors must enroll in an HMO plan offering prescription drug coverage – Medicare Advantage Plan with Prescription Drug coverage (MAPD).

Do Medicare Advantage HMO-POS Plans Only Cover In-Network Services?

No, if you have a Medicare Advantage HMO-POS plan, the options in your benefits allow you the ability to receive healthcare outside of the plan’s network.

Remember, these plans are offerings from private insurance carriers. This means the delivery of your “point-of-service” benefits and costs can differ depending on who seniors enroll with.

Medicare Advantage HMO Point-of-Service Option Enrollment

Enrolling in a Medicare Advantage (Part C) or changing plan types like an HMO-POS plan must happen during open enrollment. Medicare Annual Enrollment Period runs from October 15th through December 7th annually.

Any changes made during the Annual Enrollment Period will reflect in coverage beginning January 1st of the following year.

Seniors can also make changes if they have a qualifying life event during what is known as the Medicare Special Enrollment Period. A common example is when seniors move outside of their HMO-POS coverage area.

The Best Medicare Advantage HMO-POS Plans for You

It’s important to understand that everyone has different healthcare needs. Therefore, there isn’t a single best plan when it comes to Medicare coverage. However, there can be the best coverage specific to you. To determine if the HMO-POS plan is the best option for you, you should assess your personal factors, such as:

  • Do you often travel throughout the United States?
  • Are you able and willing to coordinate your healthcare services with the help of your primary care physician?
  • Is your preferred doctor a part of the HMO-POS network you’ll enroll in?

Depending on your needs, enrolling in a Medicare HMO Point-of-Service Option plan can be the best choice for you. Be sure to speak with a licensed Medicare agent to find the best benefits for your healthcare before making any changes to your current coverage.

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Alternative Plan Options

Medicare HMO Point-of-Service Option plans are great options, but they aren’t for everyone. Some individuals may not travel as much and seek lower monthly premiums and copayments.

In this case, a Medicare Advantage HMO plan without the POS option may be the best plan type.
However, some seniors want to coordinate their own healthcare or see specialists without needing a referral. Medicare Advantage PPO plans provide these options if members don’t mind paying a little more for coverage.

Furthermore, Medicare Advantage coverage altogether may not be right for your needs. Some seniors benefit more from enrolling in a Medicare Supplement (Medigap) plan, supplemental coverage that helps provide coverage where Original Medicare does not.

But you can’t have both a Medigap and a Medicare Advantage plan, so how do you know what’s right for you? Speaking with a Medicare agent can help. By doing so, you can weigh all of your options and determine the best course of action to fit what works best for you.

How To Find Medicare HMO Point-of-Service Option Plans for Your Needs

To find the right Medicare Advantage HMO Point-of-Service Option plan for your needs, call us today at the number above.

Our agents can compare rates, provide quotes, and walk you through all the available options for coverage. All at no additional cost to you.

Don’t have time to call? That’s okay. You can also fill out a rate comparison form online to find Medicare HMO Point-of-Service Option coverage and other plans for your healthcare needs.

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Kayla Hopkins

  • Content Editor

Kayla Hopkins is an accomplished writer and Medicare enthusiast serving as the Editor of Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.


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