Medicare is no stranger to complicated terms and abbreviations. As the years continue the more acronyms are added to the world of Medicare insurance. These acronyms are not only confusing to the Medicare beneficiary, but they can also be confusing to us Medicare insurance agents. Just when we figure out these new terms, Medicare in its infinite wisdom with either add or change the definition of an acronyms.
At Integrity Now Insurance Brokers, we want to help bring clarity to a newer term known as HMO-POS. When signing up for a Medicare Advantage (MA) plan, you may have noticed the acronyms “HMO” or “HMO-POS” following a plan name.
Here is an example of two different Medicare advantage plans. The first one is located in South Dakota: Humana (HMO). This plan states it is a standard HMO plan offered by Humana. In Texas there is a plan called: Wellcare (HMO-POS). This is a plan offered by Wellcare and is a Point of service HMO style plan.
These acronyms designate different types of MA plan types, that provide a different level of provider access.
Medicare HMO-POS Plans are a mix between HMO benefits and PPO benefits.
Point of service plans allows members to freely visit doctors outside of the plan’s network of providers. This includes specialists but the out-of-pocket costs will be higher.
A review of one HMO-POS Medicare plan broke down a primary care doctors visit showing the following cost.
In-network: $0 copay
Out-of-network: 40% coinsurance per visit
If you stayed in-network, you would pay $0.00. However, if you preferred an out-of-network doctor, you would be charged 40% of the total bill.
Like HMOs, HMO-POS plans require beneficiaries to choose a primary care physician. This is because it is still considered an HMO plan which helps coordinate care and provide referrals for specialists. This is where a PPO plan would differ.
Before you can enroll into a Medicare Advantage plan you are required to sign up for Medicare Part A and Part B.
Original Medicare (Part A and Part B) cover most of your healthcare benefits, however they do pass on cost to the Medicare beneficiary. These costs are in the form of deductibles, copayments, and coinsurance.
To fill in the gaps left behind by Medicare, you can either choose from a Medicare Advantage plan or a Medicare Supplement plan.
Medicare advantage plans are less known by its legal name of Medicare Part C. Advantage plans is a newer alternative to cover at least as much as Original Medicare.
Medicare advantage plans are allowed to provide additional benefits not included with Original Medicare.
Each Medicare advantage plan offers different levels of benefits, so it is important to conduct a thorough review of each plan. The most popular types of Medicare advantage plans are HMOs and PPOs.
Medicare HMO-POS plans offer the flexibility of a PPO with restrictions like an HMO. Although, depending on the insurance carrier, policy rules may be different.
Medicare beneficiaries are attracted to HMO-POS plans, as they often have larger medical provider networks than offered by standard HMO plans.
When attempting to choose between HMO-POS plans versus a PPO Medicare advantage plan, it will inevitably come down to coverage, price, doctor accessibility, and overall cost.
If your doctors are available in-network on the PPO plan but not the HMO-POS plan, your overall cost may be lower with the PPO option. The same is true is the opposite is the case.
You will also be considering prescription drug cost, as part of your overall cost and coverage. This is what makes Medicare advantage plans so complex and creates the issue of there not being a one size fits all scenario.
HMO-POS Medicare advantage plans will require the Medicare beneficiary to select a primary care doctor to coordinate all healthcare needs.
With the POS option included under the HMO plan, this provides additional benefits while you are traveling, outside of basic emergency room coverage.
PPO Medicare advantage plans offer the Medicare beneficiary more flexibility than HMOs including Medicare advantage HMO-POS plans. While not being required to having an assigned primary may seem like a small advantage it come with great freedom.
Because PPO Medicare advantage plans do not have a gatekeeper, Medicare beneficiaries have the freedom to self-refer to any specialist.
Many people do not appreciate having the added visit to their primary care doctor, just to obtain a referral to a specialist. This added visit takes additional time and can increases healthcare cost.
Both Medicare advantage HMO-POS plans and PPO plans provide the option to obtain care from out-of-network providers. Both plans will charge a higher fee when services are obtained from non-network doctors.
Unlike an HMO Medicare advantage plan, if you see an out-of-network doctor or medical facility, the Medicare beneficiary will not be stuck with the entire bill.
HMO-POS and PPO Medicare advantage plans typically include higher max out pocket cost. It may be a better option if available to consider a Medicare supplement plan, if you are seeking the freedoms of a PPO or HMO-POS plans.
Most Medicare advantage plans include Part D Prescription drug coverage.
If you do not have outside creditable prescription drug coverage, It will be important to sign up with a Medicare advantage plan which includes Part D coverage.
Examples of outside creditable coverage includes employers plans and Part D coverage offered through the VA Hospital.
Most Medicare advantage HMO-POS plans and PPO plans include coverage for prescriptions. Medicare Advantage Plan with Prescription Drug coverage are also known as (MAPD) plans.
When considering which Medicare plan is your best option, using an independent Medicare Agent provides you with the needed experience. They are there to help you navigate all the different types of Medicare plans and outline the pros and cons of each.
When selecting a plan, it is important to not only consider your health today but also your future health.
HMO-POS plans can be a great option for those who travel for an extended period. However, some individuals stay close to home most of the time.
A HMO Medicare advantage plan do offer some attractive low-cost benefits. They also include lower max out of pocket cost.
However, HMO plans come with all the restrictions. If you are okay with the restrictions, an HMO plan may be your best option. You may want the benefits of having a primary care doctor coordinating all your healthcare needs.
PPO plans is the broadest plans available under a Medicare advantage plan. Just remember PPO Plans come at a higher cost.
For the majority of Americans, they still prefer to stay on Original Medicare with a Medicare supplement plan in place. This gives them the freedom to see any doctor and medical facility. Depending on the plan they select, most if not all their cost to use their healthcare is zero.
We strive to help all our Medicare clients find their best plan. Integrity Now Insurance Brokers has been serving the Medicare community for over 20 years.
We are one of the top Medicare insurance agencies across the United States. We have helped thousands of Medicare beneficiaries find the right plan to take care of their medical needs.
By working with our licensed Medicare insurance agents, you instantly gain the expertise you have been looking for.
We can help you review all available Medicare plans Including HMO-POS plans, PPO plans, HMO Plans, Medicare Supplement Plans, Part D plans, and Dental, Vision, and Hearing aid plans.
Reach out to one of our licensed Medicare insurance agents today.