Medicare Choice Group

Medicare Advantage Plans: HMO vs. PPO

When it comes to Medicare, there are a lot of options to choose from. If you decide that a Medicare Advantage (MA) plan is best for you, there are two common types: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). There are some general differences between these two types of plans including the size of the network, the ability to see specialists, costs, and out-of-network coverages.

HMO Plans

These plans typically provide both medical and prescription coverage. Each plan has a network of healthcare providers and in an HMO plan, care is only covered if the provider is within the network. If you choose to go outside the network, your plan will not cover any of the expenses. Exceptions to this are emergency or urgent care as they are always covered.

Premiums in an HMO plan are generally low and there is usually no deductible. However, most HMO plans require a referral from your primary care doctor to see a specialist.

PPO Plans

Most PPO plans also include medical and prescription coverage. They also have a network of healthcare providers. You are not restricted to stay within the network as you are covered both in and out of the network. However, you can expect to have a higher copay/coinsurance cost and sometimes even a deductible for out-of-network services. A PPO plan typically has an “extended” network meaning it often reaches out of state, so it could be a better fit if you travel frequently.

With a PPO plan, the premiums are generally higher, and you do have to pay a deductible. However, you will not need a referral to see a specialist.

Which is Right for Me?

Both HMO and PPO provide similar benefits and have networks of providers. When deciding between which is better for you, it depends on each individual’s unique needs and cost limitations. At Medicare Choice Group, we can help you decide which plan is right for you. Reach out to a licensed Medicare agent today.

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