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Medicare HMO vs PPO

  • Medicare with Melissa

HMO vs PPO Insurance

Medicare offers a variety of Medicare Advantage plans, but two most popular types of health insurance plans are: HMOs and PPOs. Grab your pen or hit your print button, because in this article we compare, Medicare HMO vs PPO.

Which type of plan is right for you depends on your individual needs and preferences. If you’re looking for comprehensive coverage with minimal out-of-pocket costs, an HMO may be the best option.

If you’re willing to pay more each month for the flexibility to see any provider (doctor, hospital or facility), a PPO may be a better fit.

Regardless of the plan you choose, Medicare HMO and Medicare PPO plans are considered a “replacement” to Original Medicare (Part A and Part B) and your Medicare Advantage plan combines those benefits into something called Medicare Part C (Medicare Advantage).

Remember, Medicare Advantage plans, by law are required to cover at minimum, the same services as Original Medicare. And in most cases, they provide more than Original Medicare).

Also, Medicare Advantage Plans are not the same as Medicare Supplement Plans.

We encourage you to speak with a professional, licensed Medicare broker prior to signing up for any Medicare Advantage HMO or Medicare Advantage PPO plan. Give us a call at 866-633-4427 to speak with a licensed agent today.

Watch this short from #MedicarewithMelissa about the differences between HMO and PPO Medicare plans.

What is HMO?

Medicare HMO stands for Health Maintenance Organization. Medicare HMO plans can provide rich (good) benefits, lower costs but can also limit where you seek care.

An HMO network generally has less flexibility than a PPO network. With a Medicare HMO you may be required to get a referral to see a specialist. If you have services rendered outside of the approved network, you could be 100% responsible for payment of the services rendered.

When comparing Medicare HMO plans and before enrolling in a Medicare HMO plan, be sure to contact a Medicare broker, like Senior HealthCare Solutions to ensure your prescriptions and physicians are covered under the plan. Call 866-633-4427 today or click here to schedule your appointment.

What is PPO?

Medicare PPO stands for Preferred Provider Organization. Medicare PPO plans generally have a larger network, could have a higher monthly premium, and can have greater flexibility when seeking care from network providers. Don’t like referrals, consider a Medicare PPO plan.

Medicare PPO is not the same as a EPO (exclusive provider organization). EPOs are more geared for ACA health plans (plans for people under 65 and not on Medicare).

Medicare PPO plans can include additional benefits such as hearing, over the counter benefits, gym memberships (Silver Sneakers) and much more!

The staff at Senior HealthCare Solutions can help you compare Medicare PPO plans and be certain that your prescriptions and physicians accept the PPO plan of your liking.

Once the agent has confirmed your plan benefits, we will assist with submitting your application to the insurance carrier.

Difference between HMO and PPO

When comparing Medicare HMO vs PPO plan types, there are certainly some key differences one should be aware of. Let’s look below:

  1. Cost is a big difference between a PPO and HMO. PPO plans tend to have a higher average monthly premium than Medicare HMO plans. PPO plans will also generally have higher copays and maximum out of pocket costs.
  • Benefits is 2nd on our list of difference between PPO and HMO plans. While both plans cover hospital and physician services, Medicare HMO plans traditionally have great additional benefits such as; flex card benefits, Part B give back, credit towards over-the-counter items and much more.
  • Networks round out the list of difference between HMO and PPO plans. Both Medicare plans have a network of doctors and facilities and will offer lower out of pocket costs when staying inside the network.

However, with your Medicare PPO plan, you can go outside of the network and still be covered (you may pay more, but you’re still covered).

Whereas with a Medicare HMO plan, you may be 100% on your own if you go outside of the plan network.

Lastly, PPO plans generally do not require referrals for a specialist nor do they require a primary care physician to be assigned.

On the other hand, most HMO plans require a referral for a specialist and do require that a primary care physician be assigned to your coverage.

Dental PPO vs HMO

Since we are talking about PPO vs HMO type plans, we might as well touch on the Medicare dental plans.

Original Medicare doesn’t cover routine dental, vision, or hearing services. You can obtain Medicare Dental, Medicare Vision, and Medicare hearing coverage through private insurance plans that pair with Original Medicare.

Or, you can purchase a Medicare Advantage plan that includes dental, vision and hearing.

The big difference with a Dental PPO vs HMO is similar to the Medicare PPO and Medicare HMO plans (network and cost). HMO dental plans are generally more of a discount plan from the approved dental provider that accepts the plan.

A PPO dental plan will provide more network flexibility and is generally a set amount of cost for services rendered (unlike the discount with the HMO).

If you want help looking for Medicare dental plans or vision and hearing coverage, call us today at 866-633-4427 and our licensed agents will find coverage suitable for your needs.

Medicare Plan Misconception:

HMO coverage has much more flexibility than PPO coverage: FALSE

An HMO plan does not provide more network flexibility than PPO plans for the simple fact that most HMO plans do not provide coverage when you are outside of the network, except for seeking emergency care in emergency situations.

Frequently Asked Questions: Medicare HMO or PPO?

Is PPO better than HMO?

That depends. We often say that “better” or “best” can be different for everyone.

Can PPO plans have more flexibility? Yes.

Do HMO plans have better (lower) costs? Yes.

Each plan has pros and cons. Our licensed agents are trained and certified with over 25 top-rated carriers and will be happy to help sort your plan options. Click here to schedule your appointment.

Why would a person choose a PPO over an HMO?

Some of the biggest reasons why someone might choose a PPO vs HMO is because of network flexibility and no requirements to get a referral for a specialist.

HMO or PPO: Which should I choose?

You should choose the plan that works best for your needs and budget. Be sure you are considering your finances, health history and expectations from the Medicare plan.

Our agents bring peace of mind every day to Medicare beneficiaries by taking the time to personalize the care and attention you need when choosing a plan.

Before you enroll in a plan, be sure to call us today, 866-633-4427 and let us help you with your peace of mind and your Medicare health insurance.

PPO vs HMO: Which is better?

No way, you can’t corner us into which plan is really better. There are benefits to each Medicare plan type. After speaking with one of our licensed agents, we will easily help determine if a PPO or HMO is better suited for you.

Is a Medicare Advantage Plan better than a Medicare Supplement Plan?
That depends on your needs, budget and other deciding factors. We offer over 25 top-rated insurance companies that include Medicare Supplement and Medicare Advantage Plans.

Compare and Enroll in a Medicare Advantage HMO or PPO Today!

At Senior HealthCare Solutions, we try to provide the solutions you need to find suitable coverage. We offer over 25-top rated Medicare insurance companies.

You can compare and enroll in many ways:

  1. Compare Medicare HMO Plans online
  2. Compare Medicare PPO Plans online
  3. Speak with a licensed agent now, 866-633-4427
  4. Schedule your appointment today

Meet Melissa MacCalla

Medicare is not simple and can be hard, frustrating, and downright confusing for most. I love when I get someone on the phone and I am given the opportunity to explain the difference in plans to them and have Medicare make sense. I enjoy talking to clients year after year, hearing about their families growing or them asking about mine.


Oh my gosh!! I was so confused about the Medicare Supplement process. I am turning 65 soon and am retired and have always had insurance thru my former employer. I didn’t know a thing about going on Medicare and was struggling to sort it all out.

A friend of mine recommended contacting Senior HealthCare Solutions, so I did. Melissa was FANTASTIC!! She was professional, responsive, caring and friendly. She explained the steps I needed to take, gathered my information, helped me choose good plans for MY specific needs and took care of my applications over the phone. 1-2-3, eesy-peesy and I was done!! And it didn’t cost me a DIME!!! WOW!!! I HIGHLY recommend Senior Healthcare Solutions for anyone who’s overwhelmed with making the right choices with Medicare Supplemental Insurance and Rx coverage. It’ll take a load off your mind!

Janice W.

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