Medicare Advantage HMO vs PPO

A Medicare Advantage plan usually has networks. There are two main types of networks with an Advantage Plan, an HMO and a PPO.

HMO stands for Health Maintenance Organization. An HMO is a medical insurance group through which Medicare beneficiaries can access their health services. Your medical care will be managed through a specific network of doctors and hospitals that are specific to your Advantage Plan. With an HMO plan, you will need to choose a primary care physician who is in the network, and you will need to get referrals to visit specialists. You do not have access to out of network Doctors in an HMO. You will only be able to access out of network providers if you have an emergency situation. Most Medicare Advantage Plans are HMO’s because they usually have lower premiums than PPO’s.

PPO stands for Preferred Provider Organization. This means that the Medicare insurance company has a network of health providers who have agreed to see the plan’s members at specific negotiated rates. With a PPO plan, you will have access to Doctors in and out of the provider’s network, and you will not need a referral to visit your specialist. However, a PPO plan still has networks. You will usually get charged more money for visiting an out-of-network Doctor. The only true no-network Plans are Medicare Supplement Plans.

Please visit our Medicare Supplement page to learn more about Supplements.

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