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What are the differences between a Medicare HMO and a Medicare PPO? Get the facts and learn why the benefits of each type of plan.
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A Medicare HMO and a Medicare PPO are both Medicare Advantage Plans that utilize a provider network. Both require that you choose a primary care provider, but that's where the similarities end.
With a Medicare HMO you will be required to seek referrals from your primary care provider. You also must stay within the plan's network except in the case of an emergency.
The benefit of choosing a Medicare HMO is that you will often have lower out-of-pocket costs over other network-based plans.
With a Medicare PPO you are not required to get referrals to visit other providers. You can also go out-of-network to receive covered services. Going out-of-network when enrolled in a Medicare PPO will often require higher out-of-pocket costs.
The main benefit of this preferred provider arrangement is that you can have lower costs while using network providers, yet have the flexibility to go out-of-network if you desire.
The type of network is only one consideration of enrolling in a Medicare Advantage Plan. Review the plan's Summary of Benefits and Part D formulary as well to be certain you are choosing a suitable plan.