Medicare Advantage PPO vs. HMO

Unlike Original Medicare, Medicare Advantage plans come in many different varieties. There are four different plans, but two of the most common are PPO and HMO plans. PPO plans are typically more flexible, 

while HMO plans have a narrower provider base. Those who travel extensively tend to gravitate to the PPO plans, however, HMO’s generally have lower copays, deductibles, and max out of pocket expenses. In addition, HMO’s often provide more additional benefits for non-covered Medicare services.

If you are stuck deciding between the two types of coverage, here is some information that may be helpful. 

What Is Medicare Advantage

Medicare Advantage is an alternative to Original Medicare. While Original Medicare consists of Parts A and B of Medicare, Medicare Advantage is Part C of Medicare. Through this component of the Medicare program, beneficiaries can purchase Medicare plans that are sold by private insurance companies. The company’s plan offerings must meet Medicare’s stringent approval guidelines for each type of plan. 

What Do Medicare Advantage Plans Offer

Medicare Advantage plans have all of the same benefits as Original Medicare, but some plans offer even more. You can sometimes find supplemental benefits included in the plans as well. Some potential benefits you may find include the following:

  • Dental 
  • Vision
  • Hearing
  • Meal delivery
  • Transportation

What Are PPO Plans?

Medicare Advantage PPO plans are a certain type of plan that has specific rules that plan members most abide by. For example, PPO plans have a network of covered providers that the plan member has the choice to choose from. If they choose to seek coverage outside of that network, they may be subject to higher health care costs. Members of PPO plans do have the advantage of not needing referrals to see specialists, though. 

What Are HMO Plans?

HMO plans are more strict Medicare Advantage plans. They have a network, like PPO plans, but you cannot get covered care outside of your plan’s network. That is unless you have an emergency. Also, if you have a traditional HMO plan, you will need a referral, however, many newer HMO models allow you to see a specialist without a referral.


HMO plans are more strict than PPO plans. Due to their additional flexibility, PPO plans are typically more costly. If you go with the HMO plan, you are usually exchanging more options for lower costs.

Compare HMO and PPO Plans

There isn’t a massive cost difference between HMO and PPO plans. If you shop with one of our agents, you may find out that a PPO plan is more affordable than you thought. Regardless of which plan you decide to go with, we’d be glad to help you find it. Give Larry Klein a call now to get started.