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What is an HMO POS Plan?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 30 October 2016
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An HMO POS (health maintenance organization point of service) works very much like the standard HMO. There can be several differences and HMO POS may in general be more expensive because theses differences are pricier and offer more access to service. It should be noted both plans tend to require that people have a primary care physician who oversees medical care.

In most cases, people in an HMO must see their primary care physician and see other specialists who are in the organization. Typically coverage won’t be offered at all if people don’t use a network physician. Some of the attractions of the HMO are low cost copayments and predictable service costs.

This changes when people have an HMO POS. There is the ability to see doctors out of network, though it costs a lot more to do this. With an in-network primary care physician, people pay only the copayment for which they’re responsible. When going out of network, people can pay 50% or more of total costs. However, if this is feasible, it may be helpful to choose an HMO POS option if the HMO is not contracted with a person’s current physician.

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Another difference is the way in which the HMO POS works when it comes to specialists. In a regular HMO plan, all referrals must come from the primary care physician. When people see a specialist without a referral, these services will not be covered. In the HMO POS, people can self-refer. A visit to the specialist is likely to be covered if they use a specialist contracted with the HMO, but not at full cost, though this can vary. Self-referrals to specialists out of network also receive only a percentage of coverage instead of the usual copayment.

There is a difference when the primary care physician makes the referral. He or she may refer a patient to a network or non-network specialist and the visit may be covered at the same rate. Provided people can wait for a referral, they may be able to see any specialist their primary doctors recommend, regardless of whether that person participates in the HMO.

While there are advantages to the HMO POS, there are some disadvantages too. Due to the potential for these plans to be more expensive than standard HMOs, enrollment typically costs more. Fees can still be high when people see out of network doctors, and those who can’t afford these fees have their choices pre-limited by their economic status. It’s well to decide if the extra expense of choice that comes with these plans is worthwhile or affordable.

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anon294930
Post 4

When we buy food in a grocery store or clothing in a department store, the cheaper the cost, the worse the quality, and when you can afford to pay more then you'll get better stuff and the same applies to health Insurance or the "non traditional" Medicare Health Insurance.

The difference is that, with food or clothing and such, you can see easily why it's cheap or why it has a bad quality and such. But with health care, in order to know exactly what you get for the price you pay, you have to read about 100 pages of information, plus make several phone calls.

Monika
Post 3

I don't quite see the point of getting and HMO POS plan. You're going to pay more for that plan than just for a regular HMO, and then you're still going to pay a lot of money if you see someone out of the network.

If you want more choices, it would make sense to just go with a PPO plan. I doubt a PPO plan costs too much more than getting an HMO POS plan. In fact, you might save money in the long run because more doctors are usually covered under a PPO plan, so you won't need to see someone who is out of network.

SZapper
Post 2

@starrynight - Yeah, if you look at HMO vs. PPO, PPO will come out on top every time. Except on the price! Getting a PPO plan is usually way more expensive than going with an HMO plan.

In the past, when I was strapped for cash, I just got the cheapest insurance possible. And of course it was an HMO. HMOs are hard to deal with, but if I had to choose between having no insurance and having an HMO, I would go with the HMO.

starrynight
Post 1

I've always thought that HMO insurance plans sounded pretty bad, and the HMO POS plan doesn't sound much better. Really, there aren't that many differences between a traditional HMO vs. POS plan, just with a POS you can go out of network, but you're still going to pay an arm and a leg for it.

I prefer to get a PPO (preferred provider organization) plan for my insurance. With a PPO, you just have to see someone who is in the network, but there are usually a lot of different doctors to choose from. You don't need a referral to see a specialist or anything like that. I think it's a lot easier than having an HMO.

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