Ah, the alphabet soup that is Medicare. The journey into the Medicare world starts to see many different combinations of letters. You may see HMO, PPO, COST, PFFS, Plan A, B, C, and so on. Fortunately, we are here to help decipher the code.

In the Medicare Advantage arena, there are several options. Commonly you will see Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). Every type of plan option has its benefits, pros, and cons.

HMO-POS Medicare Advantage Plan

Sometimes you see HMO-POS. HMO-POS stands for Health Maintenance Organization – Point of Service.

These are not as commonly seen or used as the HMO or PPO options. They could be right for you.

What does that mean for you? It means you must stay in your HMO networks, but you can use some services out of the network.

To understand how the HMO-POS works examine the basics of all Medicare Advantage plans for a minute.

How does a Medicare Advantage Plan work?

A Medicare Advantage Plan (MAPD) is another way to get your Medicare benefits. Sometimes they are called Medicare Part C.

Most networked-based plans are similar to group coverage and give additional benefits to Original Medicare.

Why are there so many options?

Everyone has different needs and wants for their healthcare, but having many options allows you to find coverage that best meets your particular needs.

How do I decide if an HMO-POS is best for me?

Look at your needs and see how an HMO-POS may benefit you.

We all have doctors that we like. We have doctors we would like to see. We also want to have the most coverage for the least amount of money, right?

HMO-style plans typically contain more robust benefits than the other styles of coverage.

HMO-style plans have lower premiums, copay, and other costs. They also give a more robust benefits package. For these reasons, many people gravitate towards HMO plans.

Many times you find the plan that has the benefits that you want. Then we check to see if the doctors we want are in-network. We realize some of our doctors are out-of-network. We then look for an HMO-POS that allows those out-of-network doctors.

What do I do if I want the HMO benefits, but my specialist is not covered?

The HMO-POS shines in this situation. With an HMO-POS, you get all the benefits of an HMO-style plan but can use some services out-of-network.

Make sure to check plan benefits because HMO-POS plans have different out-of-network services they allow.

Is the HMO-POS the same as a PPO?

No, it is an HMO that has some benefits out of network. A PPO allows all benefits out-of-network, albeit at a higher cost-share to the beneficiary.

Since the HMO-POS is not a standardized plan, the services out of network can vary from plan to plan. Review plan materials to verify if the out-of-network benefits.

For example, you have an out-of-network cardiologist. You want the HMO style benefits. And you want to keep your cardiologist.

Check the HMO-POS plans in your area for one that allows out-of-network for specialists. It lets you see your out-of-network specialist.

Cant I use some benefits out of network with any plan?

Yes, but unless it’s a plan that allows out-of-network benefits for all services, you can only go out of network in emergencies.

Can I use my Medicare Card to go out of network?

No, when you enroll in a Medicare Advantage Plan, the plan is not administering your healthcare.

Medicare has assigned you over to them. Medicare no longer handles referrals and authorizations for you. The plan handles all referrals and authorizations for services.

How do I decide if an HMO-POS is a plan for me?

Do you enjoy plans that give additional benefits with fewer upfront costs? Do your needs require out-of-network providers? Does the HMO-POS in your area allow those out-of-network providers? Do you mind getting referrals?

How to Get Help Enrolling in a Medicare Advantage HMO-POS Plan

Do you need help enrolling into an HMO-POS? Do you have additional questions catered to your individual needs?

We are here to help. Give one of our licensed agents a call today or fill out our online request form. We are standing by to answer any additional questions and guide you through the enrollment process.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
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