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What is an HMO-POS?

HMO-POS stands for Health Maintenance Organization – Point of Service.

An HMO-POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowing Plan Members to seek care outside of the traditional HMO network under certain circumstances or for certain treatment. You generally get your care and services from doctors, other health care providers, or hospitals in the plan’s network. However, you are able to go out-of-network for certain services, usually for a higher cost.

2025 Plan Documents

Initial Coverage Stage

  • During this stage you pay a flat fee (copay) or a percentage of a drug’s total cost (coinsurance) for each prescription you fill.
  • The plan pays the rest until your total drug costs (paid by you and the plan) reach $2,000.

Catastrophic stage

  • After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000, you enter the catastrophic coverage stage. During this stage, the plan pays the full cost of covered Part D drugs. You pay nothing and will remain in this phase until the end of the plan year.
  • Costs may differ based on pharmacy type or status (e.g., mail order, long-term care [LTC] or home infusion, and 30, 60, or 90 day supply). You may get your drugs at network retail pharmacies and mail-order pharmacies. If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

NC Department of Insurance Special Enrollment Period extension Governor’s Severe Weather Order for Tropical Storm Helene Medicare Prescription Payment Plan (M3P)