A Medicare Advantage HMO requires you to use in-network providers for all care except emergencies and requires a primary care physician and referrals for specialists. A Medicare Advantage PPO allows you to use out-of-network providers at higher cost and does not require a PCP or referrals. PPO plans have higher premiums than HMO plans.
Key Points
- HMO: requires in-network providers, PCP, and referrals for specialists
- PPO: allows out-of-network care at higher cost, no PCP or referral requirement
- HMO: lower premiums than PPO
- PPO: more flexibility but higher premiums
- An independent agent can compare HMO vs. PPO plans in your area