Medicare PPO vs. HMO: Which one is right for you?

two senior women looking at a quarterly Medicare newsletter on PPO and HMO plans

Medicare Advantage plans come in a variety of types — two of the most common are PPO and HMO. Both types of plans offer different network and cost options.

Once you learn more about each plan type and how they work, it’ll be easier to choose the plan that’s right for you.

What do PPO and HMO mean?

  • PPO stands for preferred provider organization.
  • HMO stands for health maintenance organization.

Medicare PPO and HMO plans use a network of physicians, hospitals, and other health care professionals to give you the highest quality care. The difference between them is the way you interact with those networks.

What are the differences between PPO and HMO plans?

The biggest differences between PPO and HMO plans are network and cost. Let’s break it down for you.

With a PPO plan:

You don’t need a primary care physician. You can go to any provider you want without a referral — in or out of your network.  The additional coverage and flexibility you get from a PPO means that PPO plans will typically have higher monthly premiums. Out-of-pocket costs can also run higher with a PPO plan, too.

With an HMO plan:

Typically, you’ll have lower monthly premiums and referrals are not needed. You can expect to pay fewer out-of-pocket costs, but you’re limited when it comes to which doctors you can see. HMO plans don't cover out-of-network care.

Which one is right for me?

The decision should be about what’s most important to you.

Medicare PPO may be right for you if:

  • You’re looking for more flexibility in the doctors you see.
  • You don’t mind paying a little more for a plan with a larger network. 

Medicare HMO may be right for you if:

  • You like lower costs and don’t mind receiving care from a specific network of doctors.
  • The doctors you want to see participate in the network.

Learn more about Medicare PPO vs. HMO

To schedule a consultation with a Licensed Medicare Advisor, visit the Medicare Reservations.

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Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, and HM Health Insurance Company depends on contract renewal.

Health benefits or health benefit administration may be provided by or through Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Senior Health  Company, Highmark Senior Solutions Company, or Highmark Health Insurance Company, all of which are independent licensees of the Blue Cross Blue Shield Association.  All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.