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There are two main plan types of Medicare Advantage plans: HMO and PPO plans. What’s the difference? How do they affect my coverage and how I receive care? Knowing the key differences will help you understand what to look for when choosing a plan.
A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage Plan that provides healthcare coverage from doctors, other healthcare providers, and hospitals in the plan’s network. You typically must receive your care and services from providers within the network, except in an emergency. If you use a provider outside of the plan’s network, you may have to pay the full cost.
With an HMO plan, you’ll select a primary care physician (PCP) who will help coordinate your healthcare services and consult with other providers about your care, when needed. It’s also important to follow the plan’s rules, like getting prior approval for specific services when needed. And some HMO plans may require referrals to see specialists.
HMO plans can help you save money on your healthcare costs, as they usually offer low-cost monthly premiums, annual deductibles, and copays for office visits—often as low as $0.
Medicare Advantage HMO plans can be a good option for those who want to pay lower costs, and don’t mind staying within the plan’s network and choosing a PCP to coordinate their care.
A Preferred Provider Organization (PPO) plan is a Medicare Advantage plan that gives you the freedom to receive care from any provider or specialist who accepts Medicare—regardless of if they are in your plan’s network. PPO plan does not require you to stay within a network and will cover care received from providers not in the plan’s network.
With a PPO plan, you do not need to choose a primary care physician (PCP). This may be important if you have doctors or specialists you prefer who are not in your plan’s network, and if you spend part of the year away from home and want to receive care from providers while you are there. Also, PPO plans do not require referrals to see specialists.
PPO plans give you more choices when it comes to your healthcare, but this flexibility does come at a cost. Your copays for office visits will typically cost more when selecting a provider outside of the network. Your annual deductible, which is the amount you need to pay before your plan starts to pay for certain services, can be higher than compared to HMO plans. And PPO plans will usually have a higher monthly premium.
Medicare Advantage PPO plans can be a good option for those looking for additional flexibility and control over their healthcare choices, who don’t mind paying more in exchange for this flexibility.
Both HMO and PPO plans are Medicare Advantage plans, which cover everything that Original Medicare covers (Medicare Part A and Part B), plus provide additional coverage for dental, vision, hearing and more. Some Medicare Advantage plans, like MyTruAdvantage HMO and PPO plans, also cover prescription drugs. As an owner of MyTruAdvantage, we are pleased to offer this Indiana-based Medicare Advantage plan to our patients, neighbors and community. To learn more, visit www.MyTruAdvantage.com.
