An HMO POS is a Health Maintenance Organization with a Point of Service Option.

An HMO POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowing Plan Members to seek care outside of the traditional HMO network under certain situations or for certain treatment.

A Member may pay some additional fees for using the POS (out-of-network) option.

If I join an HMO-POS...

Can I get my health care from any doctor, other health care provider, or hospital?

You generally get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis).  However, you may be able to go out-of-network for certain services, usually for a higher cost. 

Are prescription drugs covered?

In most cases, yes.  If you want Medicare drug coverage, you must join an HMO plan that offers prescription drug coverage (MAPD).

Do I need to choose a primary care doctor?

In most cases, yes.

Do I have to get a referral to see a specialist?

In most cases, yes.  Certain services, like yearly screening mammograms, don't require a referral.

What else do I need to know about this type of plan?

• If your doctor or other health care provider leaves the plan's network, your plan will notify you.  You many choose another doctor in the plan's network.
• If you get health care outside the plan's network, you may have to pay the full cost.
• It is important that you follow the plan's rules, like getting prior approval for a certain service when needed.
• If you need more information than listed here, check with the plan.  You can find the plan's member services telephone number by clicking on the "benefits & contact info" button on our MA-Finder.com.
  

Click here to learn more about Medicare Advantage plans.