Comparing Medicare Advantage HMO and PPO plans
There are different types of Medicare Advantage plans you can choose from. The type of plan you pick will impact where you receive care and how much you’ll pay. Two of the most popular plans are Medicare HMO and PPO plans.
Under a PPO plan, you’ll have more freedom to direct your own health care while working within a list of preferred providers. With an HMO plan, you must stay within your network of providers for coverage and coordinate your care through a primary care physician.
To help you decide which plan may be the best fit for you, let’s explore each type.
Medicare Advantage PPO Plans
Preferred Provider Organization (PPO) plans offer members a list of preferred doctors, health care providers and hospitals. When receiving care from the providers and hospitals on your health insurance company’s list, you get a discount. You can also use out-of-network providers, but you’ll likely pay more with a higher copay and deductible. You may also have limited coverage for non-preferred providers until you reach your deductible.
With a Medicare Advantage PPO plan, you don’t need to select a primary care provider or need a referral to see a specialist.
Tip: Always check the plan’s directory of providers you plan to receive care from. You may find that your current primary care provider and specialist are already included in your plan.
Medicare Advantage HMO Plans
Health Maintenance Organization (HMO) plans provide health care services through a network of providers who contract with the HMO. In most cases, you’re required to receive care from providers, hospitals and clinics who are part of the network to have your care covered. If you see a provider or get care outside of the network, your plan may not cover it. There are certain exceptions to this rule, including if you need emergency care or urgent treatment and you’re outside of the plan’s coverage area.
Access our worksheet
See a side-by-side comparison worksheet of what’s included in Original Medicare, Medicare Advantage and other plan types you’re considering.
CMS ID Number: H8385_407-912-633 Article HMO PPO -PY2022-ND-SD_C, H3186_407-912-633 Article HMO PPO -PY2022-MN_C
Last Updated On: 4.22.22 at 10:30 AM