What are the differences between Medicare HMO’s and PPO’s?

Medicare Advantage plans have the option to apply for PPO’s or HMO’s. It is common for HMOs and PPOs to have prescription drug coverage included through these types of MAPD plans.

  • In PPO plans, you are not required to use in-network providers nor need a referral to see a specialist. You don’t need to choose a primary care physician. If you go out of the network, the cost sharing may be more.


  • In HMO plans, you are required to see in-network doctors and hospitals. Only in emergency situations are you allowed to go out of the network. And in some plans, such as HMO-POS, you could be able to use certain services, but at higher cost. In an HMO, you are required to choose a primary care physician.
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