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.
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.