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The Main Difference Between Medicare HMO and PPO Plans



We help clients in Winchester, VA and Martinsburg, WV who are confused with Medicare. To start off, Medicare HMO (Health Maintenance Organization) plans and Medicare PPO (Preferred Provider Organization) plans are two different types of plans that are offered by Medicare Advantage plans and there are a few differences between them.


The main difference between the two is the rules each plan has about using the plan’s provider network. Most of the time, Medicare PPO plans are more lenient when it comes to allowing users to see a provider that’s outside of the network , as opposed to the Medicare HMO plans.


What’s a provider network?


A provider network is a term used to refer to the doctors, hospitals, and any other health care providers that are under a contract with a health plan. The members of a provider network agree to accept the payment conditions of the health care plan for the services that were covered. This is what helps you manage your healthcare costs effectively.


Both the Medicare HMO and the Medicare PPO plans have a different set of rules for provider networks.


What You Need to Know about the Medicare HMO plan.

  • You have to choose a Primary Care Provider (PCP) from the plan’s network.

  • The PCP can provide general medical care, services you need, and referrals to specialists.

  • Medicare HMO plans generally charge co-payments for each type of service, may have deductibles, and may or may not have a monthly premium. ($0 premium plans are available in many areas)

  • Members of these plans are required to pay co-payments for the covered health care services after meeting the deductible.

  • Medicare HMO plans do not cover care provided from individuals outside of the network.

What You Need to Know about a Medicare PPO plan.

  • All Medicare PPO plans have a network of providers.

  • The Medicare PPO plans also offer coverage for health care received outside of the network.

  • Members of the PPO plan can see specialists without a referral.

  • Medicare PPO plans also generally charge co-payments for each type of service, may have deductibles, and may or may not have a monthly premium. ($0 premium plans are available in many areas)

  • Similar to the HMO, members of the PPO plan also pay co-payments for health care services after meeting any deductible.

Which One Is Best For You?


Although you know the differences between the two plans it’s important to get in touch with your Medicare Insurance Specialist to see which plan is a better option for you.


We are Independent Insurance Brokers, and have been appointed by many of the major insurance carriers. We can help you find the best policy for your individual situation. We work with clients in Winchester, VA, Martinsburg, WV, and Charles Town, WV.

Contact us today at (540) 662-4432 to schedule a FREE CONSULTATION with one of our Insurance agents or simply visit our website medicaretrustedagents.com to obtain more information.


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