Plans with out-of-network coverage
Medicare Advantage HMO-POS (point of service) plans cover out-of-network hospital and specialist visits.
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Senior couple meeting a doctor in her office.

What is a POS plan?

POS stands for point of service. A POS is a type of Medicare Advantage HMO plan that includes out-of-network coverage for certain services. On some CarePlus POS plans, the out-of-network coverage may have a different copay or coinsurance (your share of the cost) than if you go to one of our in-network providers. CarePlus plans with out-of-network coverage are labeled (HMO-POS).

Who is a good fit for this plan?

CarePlus has a large network of trusted providers, but in some areas a POS plan may give you more options beyond our network. This may help cover your care from a preferred doctor or hospital that’s not in our network. Depending on where you live, your cost for services from an out-of-network provider may be higher than the cost of seeing an in-network provider. Or, it may be exactly the same.

Why don’t all plans provide out-of-network coverage?

In most cases, CarePlus plans require you to see in-network doctors so we can keep your costs low while providing the best possible care. But for certain plans and areas, we recognize that out-of-network coverage can help give you more options.

Please keep in mind that even if your plan is not a POS plan, all plans cover out-of-network urgent and emergency care. In an emergency, please call 911 and go to your closest hospital.

  • You have options


    Out-of-network coverage is available on several plans with different benefits. Medicare’s Annual Enrollment Period is here, so it’s time to review your options. Please contact a licensed CarePlus sales agent or enter your ZIP code to see information.

     

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Out-of-network/non-contracted providers are under no obligation to treat CarePlus members, except in emergency situations. Please call Member Services or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

(057-CareOne Plus (HMO-POS): This plan covers certain out-of-network services for members while visiting Puerto Rico. Except in emergency or urgent situations, non-contracted providers may deny care.

(001 CareOne Plus (HMO-POS); 043 CareOne Plus (HMO-POS); 124 CareBreeze Platinum (HMO-POS); 130 CareComplete Platinum (HMO-POS); 135 CareFree Platinum Giveback (HMO-POS): This plan covers certain services received from out-of-network providers located within the plan's service area. Except in emergency or urgent situations, non-contracted providers may deny care. You will pay a higher copay for services received from non-contracted providers.

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Last Updated:

10/01/2026