PPO and HMO Plans

PPO and HMO Plans

There are several different plans involved with Medicare Advantage, two of the most popular plans being Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) Plans.

Similarities and Differences

When deciding on which of these plans would be more beneficial to you, you should consider several factors, specifically their similarities and differences.


  • Both are sold by private insurers that contract with Medicare.
  • Both offer the same coverage that is provided by Original Medicare.
  • Both typically have provider networks you can use.
  • Both plans may also include additional coverage, including prescription drug coverage.
  • Both require you to be enrolled in Original Medicare and live within their service area.


  • Unlike HMOs, PPOs will allow you to receive care outside of their provider network and still offer some coverage. You can only receive care outside the network in an HMO Plan if it is for an emergency or you need dialysis.
  • You do not have to choose a primary care physician with a PPO Plan like you would with an HMO.
  • You need a referral to see a specialist when in an HMO Plan.
  • Despite the lack of flexibility, HMO Plans generally cost less than PPO Plans. In a PPO Plan, you will generally pay a copayment for your in-network care and a coinsurance for your out-of-network care.

Which Plan Should You Choose?

As mentioned above, you need to really consider the similarities and differences of these plans to understand which plan works best for you. If you don’t mind paying more in premiums for extra flexibility with where you can receive care or treatment, then you should highly consider a PPO Plan.

If you value having a lower premium and are fine with being limited to specific network providers to receive care, then maybe look into an HMO Plan.

Don’t Just Settle For Any Coverage

Get The Coverage You Deserve

With several Medicare options to choose from, it’s easy to get overwhelmed, but Josh Burns at Capstone Insurance & Financial Group in Flowood, MS, is a Medicare expert and can help you determine your coverage and budget needs.

Give him a call today at 601-273-3690 to learn more about your Medicare Advantage options!