What's the difference between a Medicare Advantage HMO and a PPO

Which one is right for me?

The abbreviations used to describe the different types of Medicare Advantage Plans can be confusing.  Here’s a breakdown of the main categories you’ll come across.

Let’s begin with HMO, short for Health Maintenance Organization. Generally, HMO’s tend to be among the more affordable choices because they usually have zero or low premiums (the amount you pay an insurance company each month for coverage) and low deductible (the amount you have to pay first before your plan starts to foot the bill.)

Except for emergencies, HMO’s do not cover care received outside their network. If you have a doctor that you want to keep seeing, it’s important to make sure that doctor is “in-network” for any HMO you’re considering. You may also have to choose a primary care physician (PCP) in the plan network who will provide general medical care and authorize referrals to in-network specialists. Before you choose an HMO, make sure the doctors, hospitals and other health care providers you prefer to see are in the HMO’s network.

The second group is a PPO or Preferred Provider Organization. PPO's are a second type of managed care health plan. A PPO provides a large network of physicians, hospitals and other health care providers — usually larger than an HMO. Another important difference is that unlike an HMO, you can see providers outside the network for any service at any time, as long as they accept Medicare and you’re willing to pay more out-of-pocket. With some PPO's you may need to pay the non-network doctor directly, and then file a claim for partial reimbursement.

An RPPO is a regional preferred provider organization. The "Regional" part of an RPPO simply means that the network of preferred providers is not limited to one state only but crosses state boundaries within a specified region.

All Medicare Advantage Plans (including HMO, PPO and RPPO plans) offer the same coverage as Original Medicare (Part A and Part B), and they often include prescription drug coverage as well. Many also offer dental, vision and hearing care, wellness programs and other health care benefits not included with Original Medicare so be sure to check around to find a plan that provides you with the coverage you want and need.

If you have questions or would like to see what Medicare Advantage Plan options are available to you, give me a call  or email me. We will set up a time to do a review and go over your options