What Is a Medicare HMO? What are the differences between HMOs and PPOs?

What Is a Medicare HMO? What are the differences between HMOs and PPOs?

There are four types of Medicare Advantage plans. However, Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans are the most common. 

HMO Plans

Health Maintenance Organization plans require that members use health-care providers, doctors, and hospitals that are within the plan's network, unless it's an emergency situation. 
Additionally, HMO plans may require members to choose a primary care physician, and your doctor will need to give you a referral to see a specialist. Some services, like annual mammograms, do not require a referral. 
In some HMO plans, beneficiaries may be able to visit out-of-network doctors in some instances and simply pay a higher cost. These plans are known as HMO Point-of-Service (HMO-POS) plans.
Your HMO plan will generally include prescription drug coverage through a Medicare Advantage Prescription Drug plan. You will need to check with your plan first and see if you need to include a Medicare Part D plan. 

PPO Plans

Preferred Provider Organization plans do not require members to use a certain network of doctors and hospitals. They are also not required to get a referral to see a specialist. Members are not require to choose a primary care physician. 
These plans provide far more flexibility; however, members of PPO plans will generally pay lower out-of-pocket cost if they see doctors within their plan's preferred provider network. You may choose to use any doctor you like with a PPO plan, but costs could vary. 
Like HMO plans, your PPO will likely include prescription drug coverage through a MAPD. However, you will want to check to see if a Medicare Part D plan should be added. 

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What Is a Medicare HMO? What are the differences between HMOs and PPOs?