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Medicare HMO Point-of-Service Option (POS) Plans

Summary: Medicare HMO Point-of-Service Option (POS) plans provide the benefits found in both HMO and PPO plans. This provides you with greater out-of-network coverage, typically lower premiums, and other attractive features depending on your plan. A Point-of-Service plan may cover the cost of drugs, but features vary from policy to policy. Because of this and personal factors, it’s important to compare different plan types including alternatives. Licensed insurance agents can help with this process. Estimated Read Time: 6 min

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Table of Contents:

  1. What Is an HMO-POS Medicare Advantage Plan?
  2. Key Features of a Medicare Advantage HMO-POS Plan
  3. Medicare HMO vs POS
  4. Medicare HMO-POS VS PPO
  5. Medicare Part D and HMO-POS Plans
  6. Do Medicare Advantage HMO-POS Plans Only Cover In-Network Services?
  7. Medicare Advantage HMO Point-of-Service Option Enrollment
  8. The Best Medicare Advantage HMO-POS Plans for You
  9. Alternative Plan Options
  10. How To Find Medicare HMO Point-of-Service Option Plans for Your Needs

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. A Medicare HMO Point-of-Service Option plan can deliver more options and flexibility to beneficiaries.

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 therefore will affect your healthcare.

Comparing your healthcare needs and the coverage that is available in your area is key. Everyone has their own unique needs and ultimately, the right option will meet your budget and healthcare needs. Below, we’re exploring Medicare HMO POS plans and how they can help you cover healthcare costs.

What Is an HMO-POS Medicare Advantage Plan?

Medicare HMO Point-of-Service Option plans are Health Maintenance Organizations (HMOs) that also offer point-of-service (POS) benefits. You will have more flexibility when it comes to receiving care because you receive both forms of coverage. Medicare Advantage HMO Point-of-Service Option benefits require you to choose from its network of doctors and hospitals under your plan.

It’s important to note, however, that you must follow the rules and guidelines of your plan before receiving medical care. For example, you may need prior approval in order to receive coverage. When using POS Medicare Advantage 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 healthcare 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. Your coverage 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.
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. Some plans include Medicare Part D prescription drug coverage, so there’s no need to purchase a stand-alone plan.

Key Features of a Medicare Advantage HMO-POS Plan

With all of the different types of coverage and acronyms, things can feel overwhelming. Don’t worry, we get it. To help provide clarity, here are some of the key features Medicare Advantage HMO-POS plans have to offer:

  • Lower premiums are common
  • You choose your primary physician
  • Out-of-network coverage is available for some healthcare needs (referrals may still be necessary for specialists.
  • Some plans may cover your medications

Keep in mind that the individual features of each Medicare Advantage HMO-POS plan is going to vary. Still, you will need to cover your Medicare Part B premium and can expect changes to your coverage each year.

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Medicare HMO VS POS

Medicare Advantage HMO plans use networks for members. Within these networks are doctors that your plan will cover. You choose your primary physician who coordinates your healthcare and can grant referrals if a specialist is necessary. However, a POS plan offers more out-of-network coverage. You don’t always need a referral to see a specialist.

HMOs and PPOs are the most popular, while Point-of-Service plans remain less familiar. However, it’s important to note that a POS plan is a mix of HMO benefits and PPO benefits. Therefore, you can receive the best of both worlds with a Medicare Point-of-Service plan.

But remember, when using a POS plan, you may be able to receive healthcare services outside of your network. The key, however, is in order to do so, the services will need to be listed within your plan’s SOB. Overall, this is more of an exception than the rule as it varies from plan to plan.

Medicare HMO-POS VS PPO

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 traveling throughout the United States because they may cover out-of-network services as stated within your plan’s SOB.

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

Ultimately, the difference between PPO and POS is the potential for more freedom. If you have a PPO vs. POS for your coverage, you will likely have more options for healthcare. However, more options often mean higher premiums. To determine which is right for you it’s important to look at your travel habits, budget, and healthcare needs.

Medicare Part D and HMO-POS Plans

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

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

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Regardless of how you cover your medications, be sure to check each plan’s formulary. This is a list of drugs each plan will cover, and it will vary from plan to plan and carrier to carrier. Always compare the available coverage in your area to find the right one for you.

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 may allow you the ability to receive healthcare outside of the plan’s network. However, even with the plan type POS, not all out-of-network providers are available. Also, you may not need a referral as often, but you still may for certain procedures involving specialists.

Remember, Point-of-Service plans are offerings from private insurance carriers. This means the delivery of your “point-of-service” benefits and costs can differ depending on who you 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. The 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.

You can also make changes if you experience a qualifying life event during what is known as the Medicare Special Enrollment Period. A common example is when beneficiaries 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, when looking at Medicare Advantage HMO that offers a Point-of-Service option, you may find coverage that matches your healthcare and budgetary needs.
To determine if the HMO-POS plan is the right 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 right choice for you. But be sure to speak with a licensed agent to find the right benefits for your healthcare before making any changes to your current coverage.

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Alternative Plan Options

Comparing HMO vs PPO vs POS plans is important, and while Medicare Advantage plans are great options for some, they aren’t for everyone.

Depending on your needs, you may 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 at the same time. This is why speaking with a licensed agent can help you weigh all of your options and determine the right coverage 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 cost to you and with no obligation.

Don’t have time to call? That’s okay. You can also press the compare rates button below to find Medicare HMO Point-of-Service Option coverage and other plan options in your area.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. 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.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

One thought on "Medicare HMO Point-of-Service Option (POS) Plans"

  1. Thanks Ms. Kayla Hopkins — This article was very helpful in understanding the nuances between HMO, HMO-POS. It helped me decide to go with a Medicate Part C PPO plan provider.

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