What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?

Question

Larry Dalton · Accepted Answer

An HMO limits your services to a closed network of physicians and caregivers.  HMOs require members to choose one of their in-network primary care physicians to manage your healthcare, and require a referral approval to use other in-network services. HMOs generally do not allow any out-of-network services unless it's an emergency.  

PPOs are more flexible with their network of services and do not necessarily require a primary caregiver. You can use services outside of their network of treatment services, and you will still be covered. However, PPOs generally have higher prices, deductibles, copays, and coinsurance when you use services outside of their network.

Melonie Wood · Answer

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

Answered by Melonie Wood Medicare Insurance Agent

William Lawler · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-the-trade-off-between-a-medicare-advantage-ppo-and-hmo-when-it-comes-to-flexibility#william-lawler

Nikki Rowland · Answer

If you want more provider options and no referrals, a PPO is the better choice. If you’re okay with sticking to a network to save money, an HMO might be a better fit. Would you like help comparing specific plans to see which works best for you?

Answered by Nikki Rowland on April 2, 2025

Broker Licensed in SC & NC

Answered by Nikki Rowland Medicare Insurance Agent

Amy Putrino · Answer

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

Answered by Amy Putrino Medicare Insurance Agent

Thomas Ashton · Answer

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

Answered by Thomas Ashton Medicare Insurance Agent

Tom Rogala · Answer

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

Pamela Camey · Answer

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.

Jim Herro · Answer

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.

Melissa Barton · Answer

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

Answered by Melissa Barton Medicare Insurance Agent

Jane Ahrens · Answer

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

Answered by Jane Ahrens Medicare Insurance Agent

Antonio Espino · Answer

The main difference between a Medicare Advantage PPO and HMO is flexibility. An HMO plan usually has lower costs, but you must stay within the plan’s network and get referrals to see specialists. It’s a good choice if you’re comfortable using a specific group of doctors. On the other hand, a PPO plan gives you more freedom—you can see any doctor, even out-of-network, without needing a referral. However, that flexibility usually comes with higher premiums and out-of-pocket costs.

Answered by Antonio Espino on April 21, 2025

Broker Licensed in TX

Answered by Antonio Espino Medicare Insurance Agent

Betsy Mullison · Answer

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

Answered by Betsy Mullison Medicare Insurance Agent

Steve Houchens · Answer

With a PPO you have the option to see specialist or another doctor besides you PCP without the need of a referral

Julie Joyce · Answer

Network, network, network.  PPO will give you the availability to use out of network doctors and hospitals.

Cleo Martin · Answer

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

Answered by Cleo Martin Medicare Insurance Agent

Harold Randolph · Answer

When it comes to flexibility the trade of is mostly network. In an HMO you have a smaller network but you pay a little less out of pocket. You will usually need a referral to see a specialist. 

With a PPO you have a larger network and more option with doctors and networks and you pay a little more out of pocket for the convenience. 

Reach out to your broker and get more comprehensive information pertaining to senior healthcare options.

Jason Vallejos · Answer

PPO comes with higher out of pocket costs typically.  If all of your providers are in one network, HMO offers the richest benefits.

Claire Akey · Answer

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!

Steve Brauer · Answer

Well...with a Medicare Advantage PPO plan, you have a little bit of flexibility with going to a provider OUT of the HMO network, however, if you compare the PPO benefits to the HMO benefits on Medicare Advantage Plans, you'll see that for a little bit of out of network coverage, your in-network benefits suffer....and you'll get a lot less "extra benefits" like Dental, Vision, Over the Counter, etc...

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Vachik Chakhbazian · Answer

With a PPO, you have the flexibility to visit providers outside of your network. However, visiting an out-of-network provider will include a higher fee and a separate deductible. HMOs don't offer coverage for care from out-of-network healthcare providers.

Answered by Vachik Chakhbazian on April 20, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Brian Krantz · Answer

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.

Wild Bill Anderson · Answer

PPO’s allow you to go out of the PPO network but usually at a higher charge. But if the HMO network includes your providers do you need to pay more for services under the PPO?
Let’s talk about it to get you the plan that has the doctors and benefits important to you!

Kelly Linster · Answer

If given the choice choose PPO, you will not be locked into one organizations doctors. Way more options to choose.

Ron Gambles · Answer

The trade-off is cost. While you will gain a greater degree of flexibility, your portion of cost-sharing will increase what you pay out of pocket. Also, your cost could be further affected if you do not contact the Plan to verify the out-of-network treatment you are seeking is medically necessary and will be covered.

Answered by Ron Gambles on April 9, 2025

Agent Licensed in TN

Answered by Ron Gambles Medicare Insurance Agent

Glenn Alterman · Answer

PPP allows any doctor in network without a referral.  HMO tends to have more benefits and requires a referral for a specialist.

Bob Nunn · Answer

Medicare PPO has a greater Moop usually but it allows you to see a greater amount of Doctors in and out of network . Sometimes better when you are traveling.

Kerwyn Jones · Answer

PPO provides more options for provider networks, less restrictions.

You can go out of network to get another opinion from another provider without a referral.

Judi Norton · Answer

HMO's have lower copays but you must stay in-network.  PPO's have a little more flexibility for coverage with out-of-network, but the copays are a little higher.

Louanne Allison · Answer

I check to see if all their doctors are in-network with the HMO we are considering. If all doctors are in-network, an HMO can work beautifully! If there are new medical conditions that arise later and a specialist is needed, the HMO will have access to specialists as needed.

Answered by Louanne Allison on April 14, 2025

Agent Licensed in MI, FL, IL & OH, TN, TX & UT

Answered by Louanne Allison Medicare Insurance Agent

Suzanne Lamperti · Answer

An HMO is a Health Management/Maintainable Organization and one has to use the HMO's doctors and facilities. Also precaution is needed for select services.onw has more flexibility with a PPO. Also HMOs may not be available in certain areas if one travels.

Answered by Suzanne Lamperti on April 9, 2025

Broker Licensed in MD

Answered by Suzanne Lamperti Medicare Insurance Agent

Sophia Davis · Answer

I look at it from a pricing stand point. Just like a loyalty program at a supermarket, you get better pricing when you are using what they offer. A PPO might give you more options to choose from, however, it can leave your pocketbook more susceptible if something catastrophic were to happen.

Answered by Sophia Davis on April 16, 2025

Agent Licensed in OH

Answered by Sophia Davis Medicare Insurance Agent

Britania James · Answer

Under an HMO, individuals must see providers who are in-network with their insurance. HMOs generally have lower out of pocket costs and very large networks, so individuals are able to choose from many  providers.

Under a PPO, individuals are able to see providers who are in-network and out-of-network. Seeing an out-of network provider could result in slightly higher co-pays.

Kevin Chaikin · Answer

If you choose a PPO for flexibility you are usually exchanging that flexibility for potentially higher out of pocket costs (copays, coinsurance, MOOPs) and less "extra" benefits. On an HMO, for having to stay in network, you are typically rewarded with lower out of pocket costs and sometimes more extra benefits.

Answered by Kevin Chaikin on April 9, 2025

Broker Licensed in VA, AL, AZ & 31 other states

Answered by Kevin Chaikin Medicare Insurance Agent

Gregory Dunham · Answer

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.

Johnnie Jeter · Answer

Medicare advantage PPO plans offer more flexibility in choosing providers, but may have a higher out-of-pocket cost, while medicare advantage HMO plans usually require selecting a primary care provider and tend to have less provider flexibility.

Answered by Johnnie Jeter on April 8, 2025

Broker Licensed in GA & OH

Answered by Johnnie Jeter Medicare Insurance Agent

Penny Wegner · Answer

Medicare PPO plans allow you flex between healthcare systems and not select a provider at the time of enrollment. You also do not need referrals for most services. HMO on the other hand you need referrals, you to select a primary provider and most stay in network, unless an emergency. Ex. I have a client with Parkinson's Disease, he is best suited for the PPO because there is no Provider in our County that provides specialized care for him only Neurologists that the HMO want him to go to. On a PPO, he can see his Primary in town but have a family member take him to another provider out of network that does specialize in Parkinson's 60 miles away to a doctor of his choosing.

Answered by Penny Wegner on April 8, 2025

Agent Licensed in WI, CA, CO & 8 other states

Answered by Penny Wegner Medicare Insurance Agent

Larry Pereiro · Answer

With the PPO you have more flexibility to use utilize providers that are not “in network”, however, there is addition co-pays or co-insurance. With the HMO you must receive services from in network providers and you more attention to management of your health needs.

Answered by Larry Pereiro on April 9, 2025

Agent Licensed in IN

Answered by Larry Pereiro Medicare Insurance Agent

Samuel Deter · Answer

A PPO plan usually provides the most flexibility of choosing the doctors and facilities you want to use but can have higher cost and less benefits. HMO's can have lower cost and better benefits but I rarely recommend them because of the limitation of choosing providers. However, a PPO-POS can provide the best of both options.

Answered by Samuel Deter on April 10, 2025

Broker Licensed in MO, AR, GA, KS, SD & TX

Answered by Samuel Deter Medicare Insurance Agent

Taylor Blankenship · Answer

-PPO- More flexibility! You can typically go to an out of network doctor more easily.Great if you want choices. Unfortunately PPO’s usually cost more.

- HMO- Less flexible but cheaper. You pick a primary care physician, need referrals for specialists, and can only go to network providers (unless it’s an emergency).

So, if you’re all about freedom and don’t mind paying a bit more, go PPO. If saving money is key, and you’re okay with some limitations, HMO is your jam! Just like picking between adventure or comfort—choose what fits you best.

Tony Evangelista · Answer

Bottom Line
Choose a PPO if you want the freedom to go out-of-network, travel frequently, or already see providers not in an HMO network.

Choose an HMO if cost savings are more important and you're okay with coordinating care within a specific network.

Joley Hanson · Answer

When deciding between a Medicare Advantage plan, knowing your network options is important. HMO plans may not have the physicians in and out of network a PPO plan may offer. However, the plan may be cost effective if your providers are all part of the HMO network.

Answered by Joley Hanson on April 8, 2025

Agent Licensed in MN

Answered by Joley Hanson Medicare Insurance Agent

Rick Ried · Answer

Medicare advantage PPOs offer more flexibility for clients but at a higher cost.  That flexibility can be a critical advantage if the client lives in a smaller community with fewer providers.

An HMO is designed to be the most cost effective solution for clients.   This works well in larger metro areas  due to wider availability of providers and facilities. 

An HMO can be more restrictive with referrals and defined networks.  Some HMOs have stricter preauthorisation requirements designed to contain costs.  

Each client should discuss their personal situation with an agent to chose the best option.

Tonya Mowan · Answer

PPO plans give you more flexibility in choosing providers and seeking care outside the network, but at the cost of higher premiums and out-of-pocket expenses.

HMO plans are more restrictive in terms of providers and require referrals for specialists, but they typically offer lower costs, making them appealing for those who don’t mind the structure.

Ultimately, the choice comes down to how much flexibility you need and how much you're willing to pay for that freedom. If you prefer a lower cost and don’t mind staying within a network, an HMO could be the way to go. But if you value having a broader choice of doctors and hospitals, especially outside the plan’s network, a PPO might be a better fit.

Bobby Coates · Answer

The PPO is going to offer more flexibility, however the HMO is going to offer the lowest overall costs should a medical condition arise. A PPO will allow you to go out of Network (you will typically pay a little more) but the PPO will have a higher Maximum out of pocket vs a HMO.

Answered by Bobby Coates on April 9, 2025

Agent Licensed in TX, AL, AZ & 21 other states

Answered by Bobby Coates Medicare Insurance Agent

Eva Peterson · Answer

PPOs offer more choice and access to providers, including out-of-network care and usually have a low monthly premium.  You will pay differently if you seek out-of-network care but you do have the option to do so.

HMOs restrict you to their network and usually cost $0.00/mo. and you will not be able to go out of network to get care.  If you do not have specific doctors that you want or need to stay with, then an HMO would work fine for you.  Your doctor may also be in network with the HMO, and that's something your broker should be checking before you enroll to assist you in selecting the right plan.

Lenora Sikkenga · Answer

PPO plans give you access to more providers due to the fact that HMO plans require you to use the providers in the network or the cost of your care is higher. PPO ate also more flexible when it comes to traveling .

Answered by Lenora Sikkenga on April 10, 2025

Broker Licensed in NV

Answered by Lenora Sikkenga Medicare Insurance Agent

Craig Bodner · Answer

The differences between PPO's and HMO's are considerable.  Both have advantages and disadvantages: 

Medicare Advantage PPO – More Flexibility
	•  See out-of-network providers: You can see doctors and specialists outside the plan’s network without a referral, though it will usually cost more than staying in-network.
	•  No need for referrals: You do not need a referral to see a specialist.
	•  Good for frequent travelers: More ideal if you travel often or split time between states/seasons, as you have coverage outside of your primary area (at higher cost).
	•  Higher premiums and/or out-of-pocket costs: You typically pay more for the added flexibility.  It's also important to note that additional benefits such as dental are often richer with HMO's.

Medicare Advantage HMO – Less Flexibility, Lower Cost
	•  Must use network providers: You must get care from in-network doctors and facilities (except for emergencies or urgent care).
	•  Referrals required: You usually (but not always) need a referral from your primary care doctor to see a specialist.
	•  Lower premiums and copays: These plans generally cost less out of pocket, which can be a big draw for those who stay local.
	•  Often greater ancillary benefits such as dental, transportation, etc.
	•  Limited travel coverage: Not ideal if you travel a lot or live in multiple states seasonally.  

In short, the important thing is to match your priorities with the plan.  Please don't hesitate to call me at 480-773-7111 with any questions or need for assistance!

Angela Brewer · Answer

There are several trade-offs, in my opinion. With the HMO, you'll be more limited in your choice of doctors, facilities or locations, however the benefits will most likely be better than the PPO plan. The reason for this is that the PPO has to be able to cover uncertain costs due to doctors being out of network.

Answered by Angela Brewer on April 8, 2025

Broker Licensed in VA, FL, MD & 5 other states

Answered by Angela Brewer Medicare Insurance Agent

Ramiro Garcia · Answer

PPOs offer greater choice of providers, including out-of-network, but often at a higher cost, while HMOs are more cost-effective but restrict you to a network.

David Alelishvili · Answer

With a PPO, you have more flexibility to see any doctor or specialist, even outside the plan's network, without requiring a referral. This is ideal if you prefer to have the freedom to see different providers or need to travel outside your local area for care. However, this increased flexibility often comes with higher premiums, higher out-of-pocket costs, and potentially higher co-pays for out-of-network care.

On the other hand, an HMO typically requires you to choose a primary care physician (PCP) and get a referral to see a specialist. This structure limits your provider options to those in-network, but it tends to offer lower premiums, lower out-of-pocket costs, and a more streamlined care coordination process. The trade-off here is that while you save on costs, you sacrifice some freedom in choosing providers and have less flexibility, particularly if you need to see a specialist or seek care outside of the network.

In summary, if you value flexibility and are willing to pay a little more for it, a PPO may be the right choice. But if you prefer lower costs and don't mind the restrictions on provider choice, an HMO might be a better fit.

Raymond Arce · Answer

A Medicare Advantage HMO has a great network of providers to choose from but you must choose from the network that the plan provides in order for your visit to be covered. If you would like some more flexibility a Medicare Advantage PPO plan also has a network but allows you to see providers outside the network, but you may incur higher fees than you normally would. Some plans offer the same coverage in and out network, consulting with a Medicare agent to see if some of those plans are available in your area is a great start to checking all your options.

Answered by Raymond Arce on April 8, 2025

Agent Licensed in WA, CT, GA, NJ, PA & VA

Answered by Raymond Arce Medicare Insurance Agent

Ameen Abdulkareem · Answer

The major trade off is that with the HMO you do not have the autonomy to go to the provider other than your primary, without getting the primary provider's authorization in many cases. The ppo is more flexible especially when you are traveling

Answered by Ameen Abdulkareem on April 9, 2025

Agent Licensed in CT, MI, NC, NY & VA

Answered by Ameen Abdulkareem Medicare Insurance Agent

Brian Leichner · Answer

Due to the Inflation Reduction Act, there are fewer PPOs to choose from.  The reason being that PPO networks are more expensive to operate.  They insure both IN and OUT of the Network of Doctors and Hospitals.  The Inflation Reduction Act, rearranged the money.  It took from Part A & B coverages as well as dental and other ancillary benefits to pay for the Prescription drug part.  

HMOs cover only claims that are IN the Network.  They are less expensive to operate so they generally have zero premium or more dental etc.   

The real question is, what is the best route for you?  PPO?  HMO?  Neither? Let's explore this and check the Networks for you.

- Brian

Carrie April Berg · Answer

The trade-off between Medicare Advantage HMO and PPO is the option to use out-of-network providers on the PPO with a higher co-pay and out-of-pocket cost per year. Oftentimes, the PPO plans also have lower allowances for dental, vision and OTC benefits.

Answered by Carrie April Berg on April 21, 2025

Agent Licensed in NC & SC

Answered by Carrie April Berg Medicare Insurance Agent

Gina Landers · Answer

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.

Marisol Adamo · Answer

Medicare Advantage, PPO plans offer more flexibility in choosing providers (including out-of-network).  HMO plans require staying within a network, but often at lower costs.

Melinda Moros · Answer

A Medicare Advantage HMO means that your plan has contracted with specific medical providers in your local area.  You are required to use these medical providers for your needs unless you're traveling out of the area your plan covers.  You must get a referral from your Primary Care Provider before you can see a specialist, and that specialist must be an in-network provider.  If there is not an in-network provider that covers the services you need, your Primary Care Provider will make arrangements for you to see an out-of-network provider.  Your normal copayments/coinsurance would apply.  Consult your plan's Evidence of Coverage for specifics.  

With a Medicare Advantage PPO, there is a Preferred Provider network of local medical providers that will accept your plan.  You can also use medical providers anywhere in the U.S.A. that accept Medicare and agree to treat you.  However, in many cases, you will pay more if they are not Preferred Providers for your plan.  With a PPO, you don't need a referral to a specialist, unless the specialist requires one.  Sometimes providers are so specialized they want to know that you medically require their specific services.  Consult your plan materials for specifics.  

So if flexibility is important to you, or you have medical providers who are not all in the same HMO network, a PPO may be a good choice for your needs.

Jim Carroll · Answer

A PPO allows you to choose any providers in-network, and generally don't require referrals for specialist. And, although you will pay more for services, you can go to an out-of-network provider.

In contrast, with an HMO, you must select a Primary Care Physician and see that provider before you are allowed to see a specialist. That said, no services will be covered if you go out of the insurance carrier's network except for medical emergencies if you are traveling out of your network area.

Jeffrey Stoll · Answer

Ultimately you can see any Physician that accepts Medicare in a PPO plan, it will cost you less if the Physician is In-Network. In an HMO you are restricted to Physicians in the HMO unless it is an emergency situation or you are willing to pay for the entire cost of the Physician/Facility charges.

Answered by Jeffrey Stoll on April 9, 2025

Broker Licensed in IN, FL, IL, KY, ND & UT

Answered by Jeffrey Stoll Medicare Insurance Agent

Steve Thurmond · Answer

PPO = Preferred Provider Organization

Generally speaking; a PPO Medicare Advantage Plan has more flexibility when it comes to where the plan is accepted. Typically, PPO Medicare Advantage Plans will be accepted wherever Original Medicare is accepted, however it is ultimately up to the provider (Doctor, Hospital, etc...) as to whether or not they will accept your PPO Medicare Advantage Plan. 

Keep in mind, there is STILL a network associated with PPO Medicare Advantage Plans, you just have the option of receiving services OUTSIDE of the PPO Medicare Advantage Plan's PPO network, but remember, you'll also pay a higher price for services rendered OUTSIDE of the PPO Medicare Advantage Plan's network of providers.

conversely...

HMO= Health Maintenance Organization

Unlike a PPO Medicare Advantage Plan; HMO Medicare Advantage Plans are closed-network plans that do not give the plan holder the flexibility to receive care/services outside of the HMO Medicare Advantage Plan's network of providers. If you choose to receive care outside of your HMO Medicare Advantage Plan's network of providers, you will be on the hook for all costs for any services rendered. HMO Medicare Advantage Plans are truly 'Managed Care Plans'.

Nancy Suozzi-Vidal · Answer

You still want to try to secure a plan that has most or all of your preferred providers participating. A PPO plan will give you the option to see a nonpar doctor should that need arise. There is an added cost, however, if that situation arises with an HMO, you will be responsible for 100% for the nonpar provider.

Answered by Nancy Suozzi-Vidal on April 9, 2025

Agent Licensed in NY & CT

Answered by Nancy Suozzi-Vidal Medicare Insurance Agent

Heather Gray · Answer

Medicare Advantage HMO is going to be more Limited and Requires you to Have a Primary Care Doctor and Be Referred to Specialists within that Medical Group. Medicare Advantage PPO offers more Flexibly because you are able to see any Doctor that Accepts that Plan and don't Need any Referrals to Specialists.

Answered by Heather Gray on April 9, 2025

Agent Licensed in CA

Answered by Heather Gray Medicare Insurance Agent

Michael Adams · Answer

I believe it depends on the location but in general in my opinion network and available choices or lack there of.

Mark Enright · Answer

A Medicare HMO plan requires you to get your providers and services within the network or be responsible for the entire costs. You also need a referral from your primary care doctor to see a specialist. With a PPO, you can go outside of your network for care; however you will likely pay a higher price than in-network. With a PPO, you can also schedule your own appointments with a speciaiist without a referral.

Answered by Mark Enright on April 10, 2025

Broker Licensed in IL, CO, FL & 6 other states

Answered by Mark Enright Medicare Insurance Agent

Andre Hawkins · Answer

MAs ( medicare advantage ) Plans have a zero dollar premium and extra benefits such as dental vision and hearing and prescription drugs included There might be a deductible if there’s a big illness one year from $4500-$6300.

A Medicare supplement as a monthly premium that increases slightly every year, but there is zero out-of-pocket always.

What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?

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What's the trade-off between a Medicare Advantage PPO and HMO when it comes to flexibility?

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