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What Is a Medicare Advantage POS Plan?

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By Daniel Petkevich
May 10, 2023

Is an HMO-POS Plan Right for You?

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.

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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.

What's a Medicare Advantage POS Plan?

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

(Preferred Provider Organizations).
Like an HMO, this plan usually requires you to choose a

primary care physician

(PCP) who will be the first point of contact for all your healthcare needs, and you may need a referral from your PCP to see a specialist.
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.

What's the Difference Between an HMO, PPO and HMO-POS Plan?


Pros and Cons of HMO-POS Plans

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.

Pros of HMO-POS Plans

  • Lower premiums when compared to PPO plans
  • Provides coverage for out-of-network services
  • No deductible for in-network services

Cons of HMO-POS Plans

  • 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

Is a Medicare Advantage POS Plan Right for You?

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

, we have assisted numerous Medicare beneficiaries in selecting a plan that fits their budget and meets their healthcare needs. If you need help understanding each plan's pros and cons, call us at 888-454-2383. We are here to help.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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