Medicare Advantage (HMO-POS)
Medicare Advantage HMO-POS stands for Health Maintenance Organization Point-of-Service. It’s a type of Advantage plan (Part C) that provides coverage for in-network services. However, there may be some services that can be covered if you go out-of-network.​
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What is a Medicare HMO-POS plan?
Most hospital and medical services are only covered if they are completed by an in-network provider. However, there are some services that have out-of-network coverage, so you could see an out-of-network provider for that service and have coverage. However, the services that fall out-of-network will vary with each plan, so you will want to review your plan’s details for more information.
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Key Features of a Medicare Advantage HMO-POS Plan
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Must choose a Primary Care Physician
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Includes out-of-network coverage for specific services
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A referral may be required to see a specialist, but it will depend on the service
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Generally low premiums
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Can include drug coverage
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Will have annual changes
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Must pay the Part B premium
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How to Find What Services the Plan Covers
Each Advantage plan has a Summary of Benefits. This packet includes all the information you need to know about your plan. It will list each service the plan covers, restrictions on services, and your cost-sharing amounts.
You can look at this document to determine your cost-sharing for in-network and out-of-network services. Remember that you will likely have a higher cost-sharing for out-of-network services.
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How to Enroll in a Medicare HMO-POS plan
You must be enrolled in Part A and Part B to enroll in a Medicare Advantage plan. These plans are specific to your zip code and county, so you may or may not have an HMO-POS plan available in your area. If you have an HMO-POS plan available in your zip code and are within an enrollment window, you can enroll in the plan. You can use a Medicare broker, like us, or apply directly with the insurance carrier.
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When to Enroll in a Medicare HMO-POS plan
If you begin Medicare at 65, you will have a 7-month Initial Enrollment Period (IEP) to enroll in a Medicare Advantage plan. This window starts 3 months before our 65th birthday month and ends 3 months after.
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However, you can qualify for a Special Election Period (SEP) mid-year depending on your situation. You would have a 2-month window to enroll in an Advantage plan when you qualify for a SEP. An example of a qualifying event would be if you lost employer coverage or moved out of state. Additionally, if you want to enroll in a plan or change your current plan, you can do so during the Annual Election Period (AEP) each year.