Medicare Advantage HMO and HMO-POS Plans – Understanding the Differences


An HMO-POS May Provide More Flexibility

If you are in the process of shopping for Medicare health coverage, it is likely that you have seen a variety of different terms and acronyms as they relate to Medicare plans. These will typically include terms such as Medicare Advantage HMOs and HMO-POS plans.

But, although their names may appear similar, a Medicare Advantage HMO plan and an HMO-POS plan are not one in the same. If you are a Medicare beneficiary, though, it is important to understand the difference between these types of coverage, as it could affect the way that you receive your Medicare benefits.

Comparing Medicare Advantage HMO and HMO-POS Plans

Similar to a regular health insurance HMO (Health Maintenance Organization), a Medicare Advantage HMO plan will allow you to choose a primary care physician, or PCP, who will work with you in coordinating your care. Your PCP can also refer you to specialist providers who work within your network if you should require such services.

A Medicare Advantage HMO-POS (Health Maintenance Organization – Point of Service) plan will work somewhat similarly to a Medicare Advantage HMO plan. The primary difference, though, is that if you are enrolled in an HMO-POS plan, you may be allowed to receive care from health care providers who are not in your network – but only in certain circumstances.  Think of is as kind of a hybrid of a HMO and a PPO.

For example, you may need to meet certain criteria – such as residing in a specific area for a certain period of time each year – in order to qualify. In this case, for instance, you may live in Missouri for most of the year, but you spend the three winter months in Arizona.

In order to ensure that you will be able to receive the care that you need while you are out of your resident state, you can work with your primary care physician to find a provider who will be your PCP during the time that you are away.

Because Medicare Advantage plans are offered through private insurance companies, the plans and the requirements can – and often do – differ. The premium can also vary from one plan to another.

In most cases, due to the wider range of coverage, a Medicare Advantage HMO-POS plan may require a higher premium payment. These plans may also have a higher copayment requirement when you receive care. With that in mind, it is important to ensure that you have a good understanding of what is and isn’t going to be covered, as well as what your out-of-pocket cost responsibilities may be.

Is a Medicare Advantage HMO-POS Plan the Right Option for You?

So, who may be a good candidate for a Medicare Advantage HMO-POS plan? Typically, this type of Medicare plan is a good option for those who tend to travel on a more frequent basis and / or those who reside in one state most of the time, but travel and are away from home for longer periods of time throughout the year.

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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.