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Medicare Advantage: HMO Versus PPO Plans

Medicare Advantage: HMO versus PPO Plans

There are several types of Medicare Advantage plans that offer help with hospital costs, doctor visits, and other medical services that you get with Original Medicare. Two of the more common types (HMO and PPO) can be difficult to understand, so below is a simple comparison that explains the basic features of each plan type.

HMO: Health Maintenance Organization

These plans have a defined network of providers that members must use for all scheduled care. Meaning, there is no coverage for out-of-network care – except in urgent and emergency situations. HMO plans may require their members to choose a primary care physician, and most of the time this doctor will have to refer you to see any specialists.

PPO: Preferred Provider Organization

These plans also have a defined network of providers, but members have the flexibility to see doctors inside or outside of that network. If members seek care outside the network, their copayment and coinsurance costs are typically higher. PPO plans do not require their members to choose a primary care physician and referrals are not needed before seeing any specialists.

Remember that there is no right or wrong choice when it comes to selecting your Medicare plan. Having a strong understanding of all plans and how they work will help in choosing the plan that best fits your needs and budget.


For more information about Medicare, contact us at (941) 405 – 3900.

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