While shopping for health insurance coverage, you may notice letters like HMO, PPO, POS, or HMO-POS. These acronyms describe the different types of Medicare Advantage health insurance plans.
The letters for these plans are as follows, health management organization (HMO), preferred provider organization (PPO) and point of service (POS), and health management organization with a point of service option (HMO-PPO). Each type has different coverage and benefit options.
HMOs and PPOs being the most popular, while POS plans remain less familiar. Although, a POS is a mix between HMO benefits and PPO benefits.
Like PPOs, point of service plans 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, beneficiaries may need to choose a primary care physician to help coordinate care and provide referrals for specialists.
HMO-POS Medicare Advantage Plan
Original Medicare (Part A and Part B) provides necessary health care coverage, but it doesn’t provide coverage for all services.
Also known as Part C, Advantage plans cover services that Medicare doesn’t. 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 health care expenses, Advantage plans may be a good option.
All Advantage plan types wrap Part A (hospital insurance) and 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.
Additionally, plans provide extra benefits for members. Offering services like routine dental, vision, and hearing. Some plans offer worldwide urgent and emergency care and even gym memberships.
A Medicare Advantage HMO plan with a POS option is known as an HMO-POS. This is a type of plan beneficiaries may choose for Medicare coverage. HMO-POS plans allow members to receive care outside of the plan’s network, but the cost of care will be more expensive.
An HMO-POS policy has the flexibility of a PPO with restrictions like an HMO. Although, depending on the insurance carrier, policy rules may be different.
HMO-POS plans often have larger provider networks than HMOs. Although, monthly premium costs and copayments for care may also be higher for members.
HMO-POS VS PPO
Advantage plans with an HMO-POS include the convenience of having one doctor to coordinate all healthcare needs. Additionally, providing coverage for beneficiaries that do a lot of traveling within the country. Let’s use Johns’ situation for an example of how it works.
John lives in New Mexico where he has Advantage HMO-POS coverage. He’s planning a trip to stay with his mother in Arizona for 2 months. John has several health concerns and wants to make sure he can visit with a doctor while he’s away from home.
Prior to 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, PPO plans offer more flexibility than HMOs including HMO-POS policies. For starters, beneficiaries don’t need to choose one primary care physician for coordination of care. Unlike HMOs, PPOs don’t require referrals to visit with a specialist.
Both HMO-POS and PPO plans allow members to visit with providers inside or outside of the plan’s network. However, the cost will be less when staying inside a plan’s network. Likewise, the cost will be higher when receiving services from an out-of-network physician.
Let’s say John recently found some concerning skin spots and wants to see a dermatologist to get checked out. Since John has an HMO-POS plan, he can make an appointment without having to visit his primary care doctor for a referral.
Medicare Advantage Part D
Prescription drug coverage can be costly, Part D prescription drug plans can help with this expense.
In most cases, HMO-POS plans pay for prescriptions. However, beneficiaries must enroll in an HMO plan offering prescription drug coverage – Medicare Advantage Plan with Prescription Drug coverage (MAPD).
What is an HMO-POS Plan
A health management organization with a point of service option is a type of Medicare Advantage plan, an alternative way to receive Medicare benefits.
HMO-POS plans offer 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).
How Does an HMO-POS Work
The difference between HMOs with POS options and HMOs without is, the POS option allows members to see doctors outside of the plan’s network.
Although, every insurance carrier offers the “point of service” part differently. Similarly, costs may vary among insurance companies.
For most, HMO-POS policies allow members to travel within the country and still receive benefits. Many individuals like the convenience of having one provider organize all healthcare services.
Working with their PCP to coordinate care during times of travel, members don’t have the stress of finding their own provider.
HMOs without the POS option may not have coverage while outside their service area. Otherwise, the HMO-POS is the same, with the addition of the point of service option.
HMO-POS Insurance Enrollment
Enrolling in a Medicare Advantage (Part C) or changing plan types like HMO-POS must happen during open enrollment. Medicare Annual Enrollment Period runs from October 15th through December 7th annually.
Any changes made during the AEP will reflect in coverage beginning January 1st the following year. Additionally, members that move outside of their HMO-POS coverage area may qualify for special enrollment.
The Best Option for You
To determine if the HMO-POS plan is the best option for you, ask yourself some questions.
Do you travel within the U.S. a lot? Do you mind having to coordinate your health care services with the help of your primary care physician? Does your favorite doctor participate in the HMO-POS network?
If the answer to any of these is yes, an HMO-POS plan may be the best option for you. Although, members should consult with their Medicare agent prior to making any plan changes.
Alternative Plan Options
HMO-POS plans aren’t for everyone. Some individuals may not travel as much and seek lower monthly premiums and copayments.
In this case, an HMO plan without the POS option may be the best plan type. However, some beneficiaries want to coordinate their own health care or see specialists without needing a referral.
PPO plans provide these options if members don’t mind paying a little more for coverage.
We Can Help You Find The Best Policy
Using an agent to determine what type of plan is best for your healthcare needs is the best way to avoid unnecessary out-of-pocket expenses.
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