Sixty-Five Incorporated

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What does it mean if my Medicare Advantage plan is changing its name?

I got the renewal information for my Medicare Advantage plan. On page 5, it says the name will change from Elder Elite Plan (HMO-POS) to Elder Elite (HMO). What does this mean to me?

This is much more than a name change. The elimination of three letters — POS — changes the nature of the plan entirely.

This year’s plan is an HMO (health maintenance organization) plan with a point-of-service (POS) option. An HMO relies on networks. Seeing providers in the network helps ensure coverage of services. The POS option provides flexibility. A plan member can see providers outside of the network. The out-of-pocket cost will be greater, such as a $90 copayment instead of $45, but there is still coverage of the services.  

Next year’s version of the plan will be a straight HMO. What does this mean to these plan members? If they are seeing any specialists or other healthcare providers who are out of the plan’s network, things will change come January 1. They will either have to find a new doctor in-network or prepare to pay 100% for any services they receive. 

As always, 65 Incorporated recommends: Even if you are extremely satisfied with your current plan, check carefully any changes that will happen next year.  If you don’t, you could be in for some expensive surprises.  

Last updated: 12-30-2015