HMO vs. PPO Plans

Most common Medicare Advantage plans

The two most common types of Medicare Advantage plans are HMO’s and PPO’s.

Medicare HMOs

Medicare Advantage often uses HMOs (Health Maintenance Organizations) to connect you with healthcare providers. Think of it like a club – the insurance company contracts with doctors in your area to form a “network.”
Joining an HMO means you agree to receive care only from within that network, except for emergencies. Straying outside the network means that you could foot the entire bill yourself, so choose wisely!

Your primary care physician (PCP) who acts as your healthcare quarterback, and coordinates your care by referring you to specialists within the network. If your current doctor isn’t in the network, consider switching doctors to stay in your current plan network or work with us to find a plan that your current doctors and specialists are part of.

Remember that HMOs have limitations, especially in terms of network availability. Your options might be limited depending on where you live.
So, HMOs offer coordinated care within a specific network, but may be less flexible. Consider your priorities – network convenience or wider doctor choices?

Medicare PPOs

Think of a PPO (Preferred Provider Organization) like a bustling marketplace of healthcare providers. You can visit any Medicare-approved doctor you like, but staying within the plan’s network means lower costs for you. It’s like getting a discount for shopping at the preferred vendors!
Unlike HMOs, PPOs don’t require a primary care physician (PCP) to hold your hand. You’re the captain of your healthcare ship, scheduling appointments and arranging specialist visits directly. In most cases, referrals are a thing of the past with a PPO.

This freedom comes with a wider network of doctors and hospitals to choose from, making PPOs a popular option across most regions. You’re not locked into a specific group, giving you more flexibility to find the perfect fit for your needs.

So, if you value choice to navigate the healthcare landscape yourself, a PPO might be your perfect match. Just remember, while venturing outside the network is an option, it may come with a slightly bigger price tag.