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HMO vs. PPO

HMO Vs. PPO
Two of the more popular kinds of Medicare Advantage Plans include Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. Generally speaking, the difference between HMO and PPO plans includes the size of the plan network, ability to see specialists, plan costs, and coverage for out-of-network service. 

In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. HMO plans typically have lower monthly premiums and you can expect to pay less for out-of-pocket medical services. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.

PPO plans provide more flexibility when picking a doctor or hospital. For example, you are not required to select a primary care doctor. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate. Thus, you will have to pay a higher fee if you go out of your network. 

Additionally Private-Fee-for-Service (PFFS) plans are also Medicare Advantage plans, and generally have no network or a very small network. The company will allow any doctor to bill the plan as long as they agree to the plan’s terms and conditions up front. This puts the burden on you to ask your providers whether they will accept the plan before you seek medical services.

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