Medicare Advantage Plans: HMO vs. PPO

Understanding the Differences Between an HMO and a PPO

When you opt for a Medicare Advantage plan, you can choose between plans for Medicare Health Maintenance Organization (HMO) and Medicare Preferred Provider Organization (PPO). Both offer comprehensive benefits, including Medicare Parts A, B and D. However, their features, costs and levels of flexibility differ.

To decide which type of plan best meets your healthcare needs and budget, start by learning the difference between an HMO and a PPO.*

What’s an HMO?

A Medicare Advantage HMO plan generally requires you to stay within a specific network of doctors, specialists and hospitals to receive coverage. You’ll need to choose a primary care provider (PCP) to coordinate your care and refer you to in-network specialists when necessary. HMO plans typically offer lower premiums and out-of-pocket costs but with more restrictions on provider choice.

If you’re looking for lower costs and the convenience of having your providers work closely together, an HMO plan may be an excellent fit. Many Medicare Advantage HMO plans feature robust networks of care with providers and facilities in your local area. Many plans make certain exceptions for covering out-of-network care.

What’s a PPO?

With a Medicare Advantage PPO plan, you may visit any doctor, specialist or hospital, whether or not they’re in-network. However, out-of-network services cost more. PPOs do not require referrals for specialists. You should understand that this flexibility comes with higher premiums, coinsurance, copays and out-of-pocket costs.

For those who travel often or divide time between multiple locations, PPO plans offer the convenience of nationwide access.

Benefits of Medicare Advantage HMO Plans

For many Medicare beneficiaries, HMO plans offer a smart balance of affordability and quality, especially for members looking for a local care team working together. Medicare Advantage PPO plans serve those members who need more flexibility or regularly seek out-of-network providers. HMO plans, however, may attract members who prioritize affordability, coordinated care and predictability.

At its core, a Medicare Advantage HMO plan offers a straightforward approach to healthcare that keeps costs low while delivering comprehensive care. Some reasons why people are choosing HMO plans:

Saving money is a priority

With a Medicare Advantage HMO plan, you can pay little to no premium. Staying in-network leads to savings on doctor visits, prescriptions and hospital stays.

A coordinated care experience

You will select a primary care provider (PCP) to serve as your go-to for all healthcare needs. Your PCP can handle routine check-ups and help manage any ongoing health conditions, providing necessary specialist referrals. This creates a more integrated healthcare experience, with all of your providers working together to provide the best care possible.

Avoid surprise bills

Medicare Advantage HMO plans often feature predictable, affordable copays for common services like doctor visits and prescriptions, helping you better plan a healthcare budget.

Out-of-network costs

Except in the case of medical emergencies, urgent care or highly specific circumstances, your care should stay in-network. Medicare Advantage HMO plans make it easier to plan for healthcare expenses. You get peace of mind knowing that everything is set up.

Choosing between a Medicare Advantage HMO and PPO plan comes down to priorities. Consider your current health needs. By weighing the pros and cons, you can choose the plan that best fits your health and lifestyle.

Enroll Online Now

Call 866-747-8855 to join a Prominence Medicare Advantage plan during an enrollment period. The provider network presently offers members access to quality medical services in Florida, Nevada and Texas.

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* All benefits not available on all plans