When navigating the Medicare space, you might encounter several acronyms like HMO, PPO, POS, etc. Sometimes, it can be confusing and difficult to differentiate between these plans.
But, before choosing which plan best meets your needs and budget, you must understand how their coverage differs.
Let's take a closer look at Medicare Advantage POS plans, so you can decide if it aligns with your healthcare needs.
A Medicare Advantage POS plan, also known as the HMO-POS plan (Health Maintenance Organization-Point of Service) plan, is a health insurance plan that combines the features of both HMOs and PPOs
Like an HMO, this plan usually requires you to choose a primary care physician
However, an HMO-POS plan may offer some out-of-network benefits like a PPO. This means you can see providers outside the plan's network, but you will typically pay more out-of-pocket for these services.
For example, suppose you require specialist care under an HMO-POS plan. In that case, you'll typically need a referral from your primary care physician (PCP) before receiving coverage for the specialist's services. If the specialist is part of your network, your out-of-pocket costs will likely be lower. However, if you decide to see an out-of-network specialist, you'll be covered but will probably pay higher out-of-pocket costs for their services compared to in-network providers.
HMO-POS plans may be a good option if you prefer having a primary care physician (PCP) to coordinate all aspects of your healthcare. It allows for comprehensive care coordination under the guidance of your PCP, leading to a more streamlined and personalized healthcare experience.
Additionally, Medicare HMO-POS plans can offer added convenience if you frequently travel. These plans provide access to out-of-network providers, allowing individuals to receive medical care even when away from home, ensuring peace of mind and continuity of care.
However, before zeroing in on an HMO-POS plan, let's discuss its pros and cons.
Lower premiums when compared to PPO plans
Provides coverage for out-of-network services
No deductible for in-network services
Premiums are higher than an HMO plan
Need referrals to see a specialist
Higher out-of-pocket costs for out-of-network services
They may include a deductible for out-of-network care
Additional paperwork is required when using out-of-network care — you'll have to file your claims to get reimbursement
A Medicare Advantage POS or HMO-POS plan offers greater flexibility than an HMO plan as it covers out-of-network care. However, you may require referrals from your primary care physician to see specialists and may face higher out-of-pocket costs when seeing providers outside your network. Additionally, these plans generally have higher premiums than HMO plans.
If you prefer a PCP and would also like the flexibility of out-of-network services, an HMO-POS plan would be a good option compared to a higher premium PPO plan.
Nevertheless, it's essential to consider all the aspects of the plan and make an informed decision. At Fair Square Medicare
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Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc
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