Medicare
Medicare Advantage HMO or PPO: what is the difference?
An HMO plan generally requires you to use its network and often a primary care doctor for referrals. A PPO plan lets you use out-of-network doctors for a higher cost and usually does not require referrals.
How they differ
- HMO: generally in-network only except emergencies, often with referrals, usually the lower premium.
- PPO: in-network at a lower cost, out-of-network allowed at a higher cost, usually no referrals.
- Both have a yearly limit on what you pay for covered care.
How to choose
If your doctors are all in one HMO's network and you do not travel much, an HMO can fit. If you want flexibility or split time between places, a PPO may fit better. Check the doctors by name either way.
Have this ready when you call
- Your doctors and hospital
- How often you travel
- Your medicines
Common questions
Which costs more?
It depends on the plan. Compare the premium, deductible and yearly limit side by side.
What is a PFFS or POS plan?
Other plan types with their own rules. Ask us if one is offered where you live.
Related answers
Rather talk it through?
Call 855-367-1095 and a licensed agent will go through your situation with you. There is no charge to ask, and no obligation to enroll.
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