Medicare Advantage HMO and HMO-POS Plans

What is an HMO Medicare Advantage Plan?

A Health Maintenance Organization (HMO) Medicare Advantage plan requires you to use a network of doctors, hospitals, and other providers. You typically need to choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists.

HMO plans generally have the lowest premiums and out-of-pocket costs among Medicare Advantage plan types, but they offer the least flexibility in choosing providers.

What is an HMO-POS Plan?

An HMO Point-of-Service (HMO-POS) plan is a hybrid that adds some out-of-network flexibility to the standard HMO model. You can see out-of-network providers for certain services, but you'll pay more than if you stayed in-network.

HMO-POS plans are a good middle ground for people who want the lower costs of an HMO but occasionally need to see providers outside the network.

HMO Pros and Cons

Pros	Cons
Often $0 monthly premium	Must use network providers
Low copays for most services	Referrals required for specialists
Coordinated care through PCP	No coverage outside network (except emergencies)
Often includes dental, vision, hearing	Must live in plan's service area
Prescription drug coverage included	Changing plans requires waiting for enrollment period

Who Should Choose an HMO Plan?

An HMO Medicare Advantage plan may be a good fit if you:

Want to minimize monthly premiums and out-of-pocket costs
Have a primary care doctor you trust who is in the plan's network
Live in an area with a large network of providers
Don't frequently need to see specialists or travel for care
Value coordinated, managed care

Frequently Asked Questions

Do HMO Medicare Advantage Plans Require Referrals?

Most HMO plans require a referral from your primary care physician to see a specialist. Some HMO plans offer open access (no referral required) - check the plan's Evidence of Coverage for details.

What Happens if I See an Out-of-network Doctor with an HMO Plan?

With a standard HMO plan, you generally have no coverage for out-of-network care except in emergencies. With an HMO-POS plan, you may have limited out-of-network coverage, but you'll pay significantly more than in-network rates.

Can I Keep My Current Doctor with an HMO Plan?

Only if your doctor is in the plan's network. Before enrolling, use the plan's online provider directory to confirm that your doctors, specialists, and preferred hospital are in-network.