HMO vs. PPO

Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans are both part of Medicare Advantage, each with its own network, benefits, and more.

What is Medicare Advantage?

Rather than sticking with Original Medicare on its own, you can choose to opt for a Medicare Advantage plan. An Advantage plan will reduce many of the out-of-pocket costs of Original Medicare by creating and allowing you into a network of healthcare providers at a reduced cost.

Advantage plans may also offer a few additional benefits as well, such as Part D prescription drugs and limited dental, vision, and hearing coverage. These benefits vary based on the plan, however.

HMO Basics

HMO Advantage plans provide a small network for a low cost. In an HMO, you must choose a primary care physician for all your health needs. To see a specialist, the primary care physician will need to write a referral to an in-network provider. Without the referral of the primary physician, specialist care will not be covered except in emergency situations.

The main benefit of an HMO is that it is often less expensive than a PPO.

PPO Basics

With a PPO, you do not need a specialist referral. You are also not required to name a primary care physician at all. In fact, PPOs have a lot more flexibility than HMOs. With PPOs, you receive at least some coverage even out-of-network.

Because of this, you will pay more, but do keep in mind that you won’t be limited to a specific in-network provider for your care.

Find Real Answers to Your Medicare Questions with Medicare Detectives

Knowing the difference between HMOs and PPOs and which may work better for you only starts here—there’s still a long way to go in your Medicare journey towards security for the future. To learn more and make an informed decision on your coverage, call Medicare Detectives today!