HMO vs PPO Types of Medicare Advantage Plans
What’s the Difference HMO vs PPO? Discover which type of Medicare Advantage plan may be best for you.
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HMO and PPO are two popular types of Medicare Advantage (MA) plans. Let’s compare these MA plans to determine which is right for you.
HMO vs PPO Popularity FAQs
What is the popularity of HMOs?
In 2022, HMO was the most popular Medicare Advantage plan type, with nearly 60% enrollment . HMO stands for Health Maintenance Organization.
What is the popularity of PPOs?
PPO is a popular Medicare Advantage plan type that stands for Preferred Provider Organization. In 2022, 38% enrolled in local PPOs and 3% in regional PPOs.
HMO Coverage
HMOs provide in-network coverage . This Medicare Advantage plan generally covers doctors and other healthcare providers in your HMO network. The HMO plan also covers in-network hospitals.Out-of-Network HMO Coverage
HMO plans may cover the following out-of-network services:
Emergency care
Urgent care
Dialysis
Common Questions About HMOs
Can I get coverage outside of my network?
No. Generally, you must get care from doctors and hospitals inside your HMO network.
Do HMO plans cover prescription drugs?
Yes, in most cases . If you want prescription drug coverage, you must enroll in an HMO plan that includes drug coverage.
Do HMOs charge a premium?
Yes, many HMOs do charge a premium .
Do I need a primary care doctor?
Yes, HMO plans generally require you to choose a primary care doctor .
PPO Coverage
Medicare Advantage PPO plans provide in-network and out-of-network coverage. In other words, PPOs cover healthcare from any doctor or hospital . Also, if you want prescription drug coverage, you need to join a PPO plan with drug coverage.HMO vs PPO Which is Better?
To determine which type of Medicare Advantage plan is best for you, let’s compare cost and coverage.
HMO Costs
You generally pay lower premiums on HMOs versus PPOs, and your HMO deductible may be low or zero.PPO Costs
PPO plans generally have higher premiums than HMOs. In addition, PPOs typically have a deductible. Thus, Preferred Provider Organization plans usually cost more than HMOs.
Coverage Difference HMO vs PPO
PPO plans may cover out-of-network care. However, HMO plans do not cover out-of-network non-emergency care.
HMO plans usually require you to select a primary care physician (PCP), and you typically need a PCP referral to see a specialist.
Finally, coverage differs in network size. PPOs generally have larger networks and give you greater selection of in-network doctors, specialists, and facilities. So, which is best for you?
Call 1-833-463-3262 to speak with a licensed agent at Senior Healthcare Direct and discover which MA plans have the doctors and hospitals you want. You can also get a quote.
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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.