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You might have faced the HMO vs. PPO* (Health Maintenance Organization vs. Preferred Provider Organization) decision if your employer offered a choice of these types of group health insurance plans. Now that you’re planning for Medicare, you might have a similar choice if you decide to get coverage through Medicare Advantage. Let’s take a closer look at HMO vs. PPO Medicare Advantage plans to fully understand the differences.
Both Medicare Advantage HMO plans and Medicare Advantage PPO plans are offered through the Medicare Advantage program (Medicare Part C). Here are some other “HMO vs. PPO” similarities:
Medicare Advantage HMO plans and PPO plans are probably more alike than different. But there are a few “HMO vs. PPO” contrasts:
Although Medicare Advantage PPO plans may offer more flexibility, your costs (such as the monthly premium) are generally higher under a PPO.
You might need to take a more active role in care coordination in a PPO plan. For example, if you see providers outside the Medicare Advantage PPO plan’s network, you may have to give information about the medical care you have received and your prescription drugs to doctors who treat you.
With any type of Medicare Advantage plan, you’ll need to keep paying your Medicare Part B monthly premium, as well as any premium the plan might charge.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.
The pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.