What’s the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?
Answered by 16 licensed agents
I usually recommend a PPO as you can go to an out of net work provider, sometimes at a higher costs depending on the plan, more providers take PPO. PPO is Preferred Provider. HMO requires referrals, and usually have very narrow networks that you MUST stay in, if you go out of network, YOU pay
Answered by Melonie Wood on March 25, 2025
Agent Licensed in FL & AL
PPOs let you see out-of-network doctors, but at a higher cost. HMOs usually don’t. Either way, it’s important to make sure your doctors are in-network — that’s where the real savings are.
Answered by Brian Krantz on March 25, 2025
Broker Licensed in NY, AK, AL & 48 other states
This truly depends on the company you are considering enrolling with, as to how the HMO vs PPO network looks. Here's a quick example: If you are looking at a regional carrier, the HMO network, may only cover certain county, state or region. If you are looking at a national carrier, an HMO network may be spread across many counties, states or the entire country. PPO networks are most likely larger and could be spread across the country. You must verify your providers with each carrier. PPO does not equal every doctor accepts the plan.
Answered by Amy Putrino on March 25, 2025
Agent Licensed in RI, CT, FL & 11 other states
A Medicare Advantage PPO gives you more flexibility, no networks, and covers a larger territory, but normally is associated with higher copays for services. HMO's are based on the counties surrounding you and has a network to physicians and hospitals, but it has lower copays.
Answered by Thomas Ashton on March 29, 2025
Broker Licensed in FL, AL, AZ & 6 other states
The answer is simply. A PPO Medicare Advantage Plan offers greater freedom to choose providers, including those outside the network while HMO Medicare Advantage Plan generally require staying within the network except during true emergency situations. You need to follow the HMO plan rules for approved network coverage.
However, with a PPO Medicare Advantage Plan, when visiting an out of network provider will include higher fees and a separate deductible.
Answered by Pamela Camey on March 28, 2025
Broker Licensed in IL, FL, IA & 7 other states
With HMO plans you have a primary care physician and need referrals to specialist in network. PPO plans let you see doctors and hospitals in network or out without a primary care or referral
Answered by Tom Rogala on March 28, 2025
Agent Licensed in MI, AR, AZ & 10 other states
There are significant differences between HMO and PPO. An HMO is an in-network only plan, which means you may only be allowed to stay within your service area. Out-of-pocket cost is less than a PPO, and you may need a referral from your primary physician to see a specialist. However, a PPO is an in-network or out-of-network plan. PPO plans do not require referrals, and you may see a specialist anywhere you prefer. PPO plans cost more if you decide to go out-of-network, but out-of-network is statewide. I hope this answers your question. If you would like more information, you may call Melissa Barton at 472-242-8537. Thanks, and have an amazing day
Answered by Melissa Barton on March 28, 2025
Agent Licensed in NC, IL, IN & 7 other states
In general, with an HMO you are restricted to seeing doctors in that plan's network. If you go outside of the network, except in an emergency, you will not be covered. With a PPO, there is both in-network and out-of-network coverage, although you usually pay more for out-of-network services.
Answered by Jane Ahrens on March 30, 2025
Broker Licensed in NY, AL, AZ & 15 other states
On the surface the PPO provides broader access to care. It may or may not and usually with higher out of pocket exposure to the customer.
Answered by Jim Herro on March 25, 2025
Broker Licensed in WI
A Medicare Advantage PPO plan allows you to see providers outside of the carrier's network. Of course, the trade-off is that the cost of an out-of-network provider is higher. A Medicare Advantage HMO plan requires you to see a provider within the network, except in an emergency. The choice comes down to balancing provider flexibility with cost.
Answered by Betsy Mullison on April 1, 2025
Broker Licensed in CO, AR, AZ & 11 other states
Network, network, network. PPO will give you the availability to use out of network doctors and hospitals.
Answered by Julie Joyce on March 25, 2025
Agent Licensed in PA, CT, DE & 9 other states
With a Medicae advantage PPo you have a greater choice of doctors in the network, and can go out of the network if who you want to see is not in their network. If out go out of the network it will cost you more per visit. With a HMo you have a more limited amount of doctors that are in the network. You may or may not e able to go out of the network.
Answered by Cleo Martin on March 26, 2025
Agent Licensed in SC, AL, FL & GA, MI, NC & TX
With a PPO you have the option to see specialist or another doctor besides you PCP without the need of a referral
Answered by Steve Houchens on March 28, 2025
Agent Licensed in KY & TN
With an HMO you have to get referrals from your Primary Care. This helps you find which specialists to go to, but limits your available options. And you have to wait for the referral and appointment times with both your Primary and the specialist.
With a PPO you can make appointments directly with a specialist who is contracted by the insurance company and you are not limited to one particular medical group. These plans have much greater flexibiiity!
Answered by Claire Akey on March 31, 2025
Broker Licensed in CA, AZ, CO & 14 other states
It depends on where you live, which doctors and specialists you see, and which Medicare Advantage plans are available in your area. There is a perception of more flexibility with PPO plans since you can always go out of network, but that generally comes with more cost and isn't always worth it. A number of insurance providers offer HMO plans with national networks, but not all of them, which makes education on what is available in your area an important step.
Like many questions, the answer depends on your specific situation and how you plan to use your Medicare Advantage plan.
Answered by Gregory Dunham on April 1, 2025
Broker Licensed in CA & AZ
With a Medicare Advantage HMO plan you are not able to access providers OUT of Network on a NON-Emergency basis, therefore you will not receive benefits for those providers.
If you have a Medicare Advantage HMO-POS, you may be able to access certain providers OUT of Network and receive benefits.
You can however, receive OUT of network benefits for a medical emergency or urgently needed care.
A Medicare Advantage PPO plan allows you to receive benefits for IN and OUT of network providers. You may pay a higher out of pocket amount for receiving care from an OUT of network provider.
The OUT of network "Out of Pocket limit" will be higher than if using ALL IN network providers.
Answered by Gina Landers on March 31, 2025
Agent Licensed in OR, AZ, CA, NV & WA
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Advice for Seniors
Medicare Advantage
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