HMO and PPO plans are a type of Medicare Advantage plan. HMO plans stand for Health Maintenance Organization plans, while PPO refers to Preferred Provider Organization Plans.

We’ll examine the features and differences between HMO and PPO plans.

HMO Plans

HMO plans are sold by private insurance companies that are approved by Medicare. To enroll for an HMO plan, you must have Original Medicare. 

Like other Part C plans, HMO plans cover the same services that Original Medicare covers. Health Maintenance Organization plans often cover additional services such as prescription drug coverage, dental, and vision. HMO plans have a list of in-network healthcare providers that are approved by the plan. This means to get coverage for medical services, you must visit a provider within the network. If you go out-of-network, you may have to cover the full cost. HMO plans only cover out-of-network care if you need dialysis or urgent care when traveling. 

HMO plans also require you to get a referral for specialist visits. 

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PPO Plans

Preferred Provider Organization plans are a type of Part C plan which offers more freedom than HMO plans. Under PPO plans, you can get inpatient or outpatient medical care from out-of-network providers, though you will pay more if you choose to go out-of-network. PPO plans also have a list of healthcare providers that are within the network. PPO plans do not require you to get a referral for specialist visits, and you do not need to choose a primary care physician.

PPO plans cover the same services as HMO plans and also cover additional services such as dental, vision, and fitness memberships.  

To enroll for PPO plans, you must have Original Medicare and must continue paying your Part B premium. Both plans have an annual out-of-pocket maximum limit. However, if you desire more flexibility, then you can purchase a PPO plan. PPO plans allow you to go out of network and also keep your current physician.

HMO and PPO plans both cover the same services but still have their key differences. To learn more about both plans and to determine which of these plans fits your needs the most, contact Lifetime Medicare Partners today by giving us a call at 800-971-2989.