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What is Medicare HMO? What is Medicare HMO or PPO? When we are talking about Original Medicare with a Medicare Supplement you don’t have HMOs or PPOs or network restrictions. The alternative to Original Medicare is Medicare Advantage. Medicare Advantage has HMO or PPO and network restrictions that go along with them.
HMO is a health maintenance organization. You usually get one primary physician who coordinates everything for you. Generally you need to get referrals to see specialists & need to have prior authorization. You can see out-of-network providers for a higher fee with separate fee structure deductibles.
Compare that to a PPO which is Preferred Provider Organization . You have more flexibility then you pay for seeing doctors and healthcare providers within that network. You generally don’t need referrals. People with PPOs are responsible for scheduling appointments and paying the corresponding extra fees. The deductibles are usually combined. So that’s the difference between the HMO and PPO. Look here on the screen and you can see specifically the differences.
Again we are not going into the discussion about too much more about HMO and PPO because Medicare Supplements do not have anything to do with HMOs and PPOs. You will only be subject to HMO/PPO if you choose a Medicare Advantage plan. Check out the Article on differences between Medicare Advantage and Medicare Supplement here.
The biggest difference between Medicare Advantage & Medicare Supplement is the amount of money that you could have to pay if you get sick. Medicare Advantage maximum out of pocket is $6700 every year. It starts again on the 1st of the year. Compare this to a Medicare Supplement where there is nothing close to that. There are no Network restrictions on Medicare Supplement compared to Medicare Advantage. These are the biggest differences. It depends on if you have PPO or HMO within the Medicare Advantage plan. Keep in mind that no copay for the supplement (Plan F & Plan G) versus the Medicare Advantage.
You can travel with the Medicare Supplements. If you need to go to the Mayo or MD Anderson those are okay on the Supplement but not on the Advantage. With the Medicare Advantage like we saw here on the HMOs and PPOs structure, you have to have things pre-certified. You can’t just go to doctors without a referral. You are subject to referrals, pre authorizations and Pre-certifications. Medicare Supplements can’t drop you unless you don’t pay your premiums. That’s the only way they cancel you, so make sure that’s paid. But on the Advantage plan you can be cancelled or they can leave the area. These are just some of the differences between the two.
Thank you for checking out What are HMO and PPO in Medicare. Feel free to give us a call with any Medicare questions. We’re happy to help. Our number is (888) 506-7510. Or if you are like so many folks that are just confused by so much information in Medicare have a look at our 6-Part Medicare mini course. You’ll find that at www.GetMedicareSavings.com.