HIGH-QUALITY
HMO-POS PLANS

Our Plans

New Hanover Health Advantage offers two high-quality HMO-POS plans:

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.

2024 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 $5,030.

Coverage Gap Stage (“Donut Hole”)

  • Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer combined with the 25% you pay, count toward your true out-of-pocket .
  • Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount)
  • Once your total yearly out-of-pocket costs reach $8,000, you move to the catastrophic coverage stage.

Catastrophic stage

  • Your share of the cost for a covered drug will be either coinsurance or a copayment, whichever is the larger amount:
  • – either – coinsurance of 5% of the cost of the drug
  • –or $4.15 for a generic drug or a drug that is treated like a generic and $10.35 for all other drugs.
  • Our plan pays the rest of the cost.

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