October 5, 2021
Medicare Advantage insurance plans are offered by private insurance companies and cover both hospital visits and doctor visits, among other benefits. Because they are offered by private insurance companies, Medicare Advantage plans use provider networks such as HMOs and PPOs, unlike the traditional network-less Medicare plans. It doesn’t matter to doctors which network you select but be sure that your doctor is in-network, which will generally more cost-efficient than going outside of network..
Wondering which network is best for you? Learn about the differences between HMOs and PPOs and how they affect your access to health care.
What is HMO?
Health Maintenance Organizations (HMO) health insurance plans include access to a select network of hospitals and doctors. This network is comprised of quality-assured healthcare providers who offer lower rates for plan members.
With HMO plans, your care is only covered if it is done by providers within your plan’s specific network. These plans may also feature additional restrictions such as limits on visits, treatments, and tests, or they may require a primary care physician referral to see specialists. Many HMO plans require that you select a primary care physician.
Typically, HMO premiums are lower and provide additional benefits like coverage for deductibles.
What is PPO?
Preferred provider organization (PPO) health insurance plans allow members to save money when accessing care within the plan’s network. You can still seek care outside of the plan’s network, though you may be required to pay a higher cost. These plans offer more flexibility and generally do not require that you select a primary care physician to make referrals.
Premiums tend to be higher with PPO plans, and you may be required to pay deductibles. These increased rates are balanced by increased benefits.
You can still receive coverage when seeking care outside of your network and will not be required to obtain a primary care physician referral to see specialists. Typically, PPO networks have a larger number of hospitals and doctors.
HMO vs PPO
Below is a general comparison of HMO plans and PPO plans. For personalized assistance figuring out which plan is best for you, check out our Plan Comparison Tool.
- Costs: PPOs typically cost more than HMOs due to increased coverage and flexibility
- Plan Networks: PPOs tend to have larger networks than HMOs. Networks can change year-to-year, so be sure to stay updated with your carrier.
- Coverage Outside of Your Plan’s Network: For both types of plans, coverage for in-network healthcare providers is better. PPOs may offer some coverage for visits to providers outside of your plan, whereas HMOs usually do not.
- Primary Care Physicians: HMOs may require that you select a primary care physician, and you may only be able to see a specialist with a referral from one. PPOs usually do not require that you select a primary care physician, and you generally do not need a referral from one to access specialist care.
Getting Help Selecting Your Medicare Plan
Not sure which plan is best for you? Thankfully, our licensed insurance agents can help you explore the options and inspire confidence in your decision!
Visit our Plan Comparison Tool or give us a call at (888) 411-7647 TTY: 711 to get help selecting the best plan for you.
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