HIGH-QUALITY
HMO-POS PLANS

Our Plans

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

What is an HMO?

HMO stands for Health Maintenance Organization. HMO plans typically have lower monthly premiums. With an HMO you can typically expect to pay less out of pocket. With most HMO plans, all your healthcare services are coordinated by your primary care provider (PCP). Most HMOs require you to obtain a referral from your PCP to see a specialist. HMOs do not offer coverage for care from out-of-network healthcare providers. The only exception to this is for medical emergencies or urgently needed services.

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.

2021 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 $4,130.

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 TrOOP .
  • 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 $6,550, 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 –$3.70 for a generic drugs or a drug that is treated like a generic and $9.20 for all other drugs.
  • Our plan pays the rest of the cost.