HMO and PPO are both types of Medicare Advantage plans. HMO stands for Health Maintenance Organization plans, while PPO stands for Preferred Provider Organization plans. While both plans have in-network providers, there are some major differences between them. In this guide, we’ll consider the differences between HMO and PPO plans and which is the best plan for your healthcare needs.
HMO Plans
Health Maintenance Organization plans are a type of Part C plan that private insurers sell. Health Maintenance Organization plans require in-network care, i.e., beneficiaries are only covered if they get healthcare services from approved healthcare providers, except for if dialysis or emergency medical care is needed. Other than this, if you get out of network care, you will most likely have to cover 100% of the costs. Also, under an HMO, beneficiaries are to select a primary care provider and get referrals for specialist visits.
Like other Part C plans, HMO plans cover the same services Original Medicare covers, such as hospital insurance and medical insurance. Many HMO plans also offer coverage for prescription medications and other extra benefits.
PPO Plans
Medicare Advantage PPO plans are more flexible than HMO plans. Like HMO plans, PPO plans have a list of in-network providers. However, you can still receive coverage if you get out-of-network care while enrolled in a PPO plan.
Under a PPO plan, you are not required to choose a primary care physician, nor do you need to get referrals for specialist visits. Like HMO plans, PPO plans cover the same services as other Medicare Advantage plans, which include the same coverage as Original Medicare and extra benefits like prescription drug coverage.
Which Is Better?
The best option truly depends on your medical and financial situation. And, of course, other factors can make either PPO or HMO plans suitable for you. For example, suppose you prefer more flexibility with network providers. In that case, a PPO plan may be right for you as it covers in-network and out-of-network care. However, you’d have to pay more for out-of-network care. If you’re fine with being limited to and receiving care from your plan’s in-network providers, then you can enroll in an HMO Part C plan.
HMO and PPO plans offer the same type of coverage. However, it’s common for people with chronic health conditions to switch from HMO plans to other Part C plans, like PPO, due to the flexibility. The cost of both plans varies depending on the coverage features, location, and provider.
A Better Way to Get Medicare Coverage
If you need help deciding on your Medicare Advantage coverage, reach out to Eldridge Agency today. We’re local to the Reno, NV, area and can help you find a plan that fits your needs. Contact us today at (775) 328-1197.
