Understanding HMO and HMO-POS plans – how they are alike (and different)

August 13, 2020
comparing HMO and HMO-POS Medicare Advantage plans

Healthcare has a language of its own, full of terms and acronyms that can be confusing. At Aspire Health Plan, we want to clear up any confusion as best we can. When looking closer into Medicare Advantage plans, you may have noticed the acronyms “HMO” or “HMO-POS” following a plan name. These acronyms designate different Medicare Advantage plan types.

  • HMO stands for health maintenance organization
  • POS stands for point oservice

How are HMO and HMO-POS Medicare Advantage plans alike?

HMO and HMO-POS plans have a lot of the same features. These include a defined list of providers, known as a network, which members of the plan use for care and services. With HMO plans, you generally must get your care from your provider network, except urgent or emergency care, out-of-area urgent, or out-of-area dialysis. Typically, both HMO and HMO-POS plans require that you select a primary care physician (PCP) in your provider network.

How are HMO and HMO-POS Medicare Advantage plans different?

The major difference between HMO and HMO-POS plans revolves around the plan’s network. An HMO-POS plan’s network allows plan members to see care outside of the HMO network. Note that out-of-network services usually come at a higher cost, but you are still required to choose an in-network PCP that can best coordinate your care. Most HMO-POS plans have higher monthly premiums than HMO plans, but lower co-pays for doctor office visits, specialty care visits, inpatient and outpatient care and more.

Which Medicare Advantage option is right for me?

Do you travel a lot? If you do a lot of traveling within the U.S. and you want the convenience of having one doctor coordinating all your care, an HMO-POS plan might be right for you. Many people living in Monterey County travel or visit family and friends for extended periods of time, and an HMO-POS plan can offer peace of mind while still having Medicare coverage.

Aspire Health Plan offers two HMO and one HMO-POS Medicare Advantage plan. For all of our plans, any urgent or emergency care that arises within the U.S. or its territories is covered, and you do not need to obtain authorization prior to seeking care. Members can receive care at any hospital in Monterey County: Community Hospital of the Monterey PeninsulaSalinas Valley Memorial Healthcare SystemNatividad Medical Center or Mee Memorial Hospital. You can head over to the Plans & rates section of our website to learn more information, use our plan comparison tool and get an overview benefit highlights.

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