Medicare Advantage Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO)

HMO Plans vs. PPO Plans

Unlike Original Medicare, Medicare Advantage (Medicare Part C) coverage is based on the insurer’s preferred specifications. Getting the best Medicare Advantage (MA) plans usually involve choosing between Medicare Advantage Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO).

To choose the best Medicare Advantage plan for you, consider your budget and flexibility you need in a healthcare plan. Let’s compare the Medicare Advantage HMO and PPO Plans to help you understand which one might be right for your needs.

Provider Networks

One of the most significant differences between HMO and PPO Plans is the level of freedom a plan member has to go outside the healthcare providers network to receive coverage and care. With HMO, you must stay in the plan’s network if you want the plan to help you cover healthcare costs. However, the plan will pay its part during an emergency, regardless if care was received from the network provider or not.

With the Medicare Advantage PPO plan, a member has the option to go outside the network of the plan’s provider – though you will pay more if you receive care outside the plan’s network. Moreover, with an HMO plan, you must choose a primary care physician to coordinate your healthcare and refer you to specialists. In contrast, you don’t need a referral to see specialists or need a primary care physician with PPO.

Cost

HMO plans are typically less expensive than PPO plans. Several HMOs offer $0 monthly premiums with no annual deductible. HMOs mostly depend on care coordination by the small network provider to control costs and promote quality.

PPOs, on the other hand, have a monthly premium and annual deductible. However, the deductible only applies to the member that seeks out-of-network care. Usually, you’ll have to pay more for any service received outside the network. Besides that, the PPO copayments, coinsurance, and deductibles may be similar to HMO plans if the services are delivered by the plan’s network.

Services Covered

The coverage offered under Medicare Advantage HMO and Medicare Advantage PPO plans depends on the type of plan taken and the plan provider, but the services covered are usually similar.

Prescriptions Drug

HMOs also require you to get your prescription drugs filled and covered within the network as well. In contrast, PPOs allow you to fill a prescription anywhere though it comes with extra charges to get your prescription outside the network.

Which Medicare Advantage Plan is Better for You?

Each plan has its benefits, and selecting between the plans is entirely up to your healthcare needs and budget. Some Medicare beneficiaries like the HMO plan’s coordinated care, while others enjoy the flexibility and freedom that PPO plans offer.

To learn more about these plans and the best one for your needs, contact Turning 65 Solutions to speak with a licensed insurance agent.

Turning 65 Solutions can help you plan for the future.