Medicare Advantage HMO-POS, which stands for Health Maintenance Organization Point-of-Service, is an Advantage plan (Part C) that offers coverage for in-network services. Nevertheless, there might be certain services that could be covered even if you choose to go out of network.
In order to receive coverage, it is important to note that the majority of hospital and medical services must be performed by an in-network provider. Nevertheless, there are certain services that offer out-of-network coverage, allowing you to seek treatment from a provider outside of your network. It is worth mentioning that the specific services covered out-of-network may differ depending on your plan. Therefore, it is advisable to carefully review the details of your plan to obtain more comprehensive information.
Features of the HMO-POS Plan
Here are several important aspects to consider regarding your HMO-POS plan:
1. Selection of a Primary Care Physician is mandatory.
2. The plan provides coverage for specific services even if they are out-of-network.
3. Depending on the service, a referral may be necessary to consult a specialist.
4. Generally, the premiums for this plan are low.
5. Drug coverage can be included in the plan.
6. The plan undergoes annual changes.
7. It is essential to pay the Part B premium.
Services Covered by the Plan
Each Advantage plan is accompanied by a comprehensive Summary of Benefits. This package contains all the essential details pertaining to your plan, providing you with the necessary information. It outlines the services covered by the plan, any limitations on these services, as well as the amounts you are responsible for sharing in terms of costs.
By referring to this document, you can easily ascertain the cost-sharing requirements for both in-network and out-of-network services. It is important to note that you may incur higher cost-sharing for services obtained outside of the network.
Enrolling in a HMO-POS Plan
To enroll in a Medicare Advantage plan, you need to be enrolled in both Part A and Part B. These plans are tailored to your zip code and county, meaning that an HMO-POS plan may or may not be an option in your area. If an HMO-POS plan is available in your zip code and you are in an enrollment period, you are eligible to sign up for the plan. You have the option to enlist the help of a Medicare broker, such as our services, or apply directly through the insurance provider.
Private insurance companies market Advantage plans. Any Medicare Advantage insurance provider has the option to provide an HMO-POS plan. Nevertheless, it is at their discretion whether they choose to offer it in your specific zip code and county, which means that certain companies may not have this plan available in your area.
Takeaways
The coverage of certain services may vary depending on your plan and whether they are in-network or out-of-network. Medicare HMO-POS plans usually have affordable premiums and provide drug coverage. The availability of this plan is contingent upon the carriers that offer it in your specific area.
Mario Arce
I have been working with Medicare clients since 2016. I serve California members in San Bernardino & Riverside county.
