What does HMO-POS mean?

HMO-POS stands for Health Maintenance Organization with a point-of-service option.

This is one type of Medicare Advantage plan.

An HMO-POS plan has features of an HMO plan. One is a defined list of providers, often referred to as a network, that members must use for care and services. The plan may require the member to have a primary physician who coordinates care and there may be prior authorization requirements.

However, there is one big difference. An HMO-POS plan allows members to use healthcare providers that are outside the plan’s network for some or all services. For example, one HMO-POS plan will cover out-of-network hospitalization but not mental health care. In most cases, a referral from the primary physician is required and authorization may be necessary. The plan has separate deductibles and out-of-pocket limits for in- and out-of-network services. 

The member will pay more for out-of-network services and the plan may limit use. However, this option provides an element of flexibility not available with an HMO plan.