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Understanding Medicare Advantage HMO-POS Plans

Read all about Medicare Advantage HMO-POS Plans. We break down this plan type and give you clarity on when & who should consider these plans.

3 mins read
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If you are on eligible for Medicare, you may have heard of Medicare Advantage plans. These are health insurance plans offered by private insurance companies, which provide all the benefits of Original Medicare, and often additional benefits as well.

One type of Medicare Advantage plan is the HMO-POS plan. In this blog post, we will explore what an HMO-POS plan is, how it works, and the benefits it can offer to seniors.

What is an HMO-POS Plan?

An HMO-POS plan is a type of Medicare Advantage plan that combines the benefits of an HMO (Health Maintenance Organization) plan and a POS (Point of Service) plan. Like an HMO plan, an HMO-POS plan requires you to choose a primary care physician (PCP) who will be responsible for coordinating all of your healthcare needs. If you need to see a specialist, your PCP will refer you to one. In addition, HMO-POS plans usually have a network of healthcare providers that you must use in order to receive coverage.

However, unlike a traditional HMO plan, an HMO-POS plan also allows you to receive care from providers who are outside of the network but at a higher cost. This is where the POS aspect of the plan comes in. If you choose to receive care from a provider who is outside of the network, you will have to pay more out-of-pocket costs than if you had stayed in-network.

The Benefits of an HMO-POS Plan

One of the main benefits of an HMO-POS plan is that it provides you with more flexibility than a traditional HMO plan. While you still have to choose a PCP and stay within the network for the most part, you do have the option of receiving care from providers who are outside of the network. This can be especially beneficial if you live in an area where there are not many healthcare providers in the network, or if you need to see a specialist who is not in the network.

Another benefit of an HMO-POS plan is that it often includes additional benefits that are not covered by Original Medicare. These benefits can include things like dental, vision, and hearing coverage, as well as fitness programs and wellness benefits. Some HMO-POS plans also offer prescription drug coverage, which can be very helpful if you take a lot of medications.

The HMO and POS portions of the plan have separate deductibles. Care you receive in-network through the HMO has a different deductible than care you receive out-of-network through the POS. The two deductibles cannot be combined – they must be reached separately.

How to Choose an HMO-POS Plan

If you are interested in enrolling in an HMO-POS plan, it is important to do your research and compare different plans before making a decision. Look at the network of healthcare providers to make sure there are enough providers in your area. Check to see what additional benefits are included in the plan, and whether they are benefits that you will actually use. Finally, consider the out-of-pocket costs, including deductibles, copays, and coinsurance, to make sure the plan is affordable for you.

It is also important to consider your own healthcare needs when choosing an HMO-POS plan. For example, if you have a chronic condition that requires frequent visits to a specialist, you may want to choose a plan with a wider network of specialists or a plan that will cover out-of-network services such as a Medicare Advantage PPO plan. On the other hand, if you are generally healthy and only need to see a doctor for routine check-ups, a plan with a smaller network of providers may be more affordable and still meet your needs.


An HMO-POS plan can be a great option for seniors who want the benefits of an HMO plan, but with a little more flexibility. These plans can offer additional benefits, the option to receive care from providers who are outside of the network, and lower out-of-pocket costs than traditional Medicare plans. If you are interested in enrolling in an HMO-POS plan, make sure to do your research and choose a plan that meets your healthcare needs and budget.


CoverRight is on a mission to make the Medicare plan selection process easy to understand. We are here to help you compare Medicare plans and find the one best suited to your specific situation. Try the platform for yourself.

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Richard Chan

Richard is the Founder of CoverRight and based in New York. He is passionate about empowering consumers to take control of their health and finances. Prior to starting CoverRight, Richard had extensive experience working in financial services with over 8 years' experience in consumer lending and investment banking.

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