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There are two types of Medicare Advantage plans that are taken into account when choosing your Medicare Advantage plan, which could make a huge difference in your coverage.

HMO Plans

HMOs or Health Maintenance Organization plans, offer the same coverage as Original Medicare and sometimes come with a prescription drug coverage as well. Depending on which plan you choose, you could also get additional coverage on vision, dental and hearing services.

However, there’s a catch. HMOs work with a strict network system, meaning, you will need to receive health care services from a provider or facility that is within the plan’s network in order to receive coverage. You will also most likely need to get your prescriptions from a preferred network of pharmacies and require a referral from your primary care physician when specialist services are needed to be covered. The only exception is in the event of an emergency, urgent care, or dialysis treatment. 

A special type of HMO plan that can provide some out-of-network coverage is an HMO with a point-of-services (POS) option. It will still cost you less if you remain within the in-network providers. 

PPO Plans

PPO or Preferred Provider Organization plan will cover all the same services and items as Original Medicare. Part D coverage is usually covered by PPOs as well. 

The difference between a PPO and HMO is that PPOs are a bit more flexible when it comes to working with out-of-network providers. PPOs will help cover services by providers and facilities that are outside of the plan network but it will always cost less if the individual remains in-network. Another difference is that with PPO, for in-network care, you often pay copayments while for out-of-network care, you pay coinsurance. You also would not need a referral in order to see a specialist under a PPO plan.

Still can’t decide between HMO or PPO? 

You have to take into consideration two things: cost and availability. The availability refers to how they treat their network. While HMOs are strict when it comes to working with out-of-network providers, PPOs have a greater range of coverage since they allow out-of-network services. If you wouldn’t like to be restricted in where you get health care, even if you may have to pay more, a PPO is the best option for you.

In terms of pricing, the benefit of HMOs is that they come with lower monthly premiums and costs than PPO plans. Keep in mind that individual plans, both for HMOs and PPOs, cost varies depending on coverage and the insurance company. However in general, HMOs have lower out-of-pocket costs due to their exclusive network. 

It is important to consider both needs now and in the future when deciding between HMOs and PPOs. Do you value cost-saving or flexibility with available providers? It is also important to consider the benefits that each plan provides, such as extra coverage in dental, vision, or hearing care. 

The best way to figure out which plan fits your needs is through speaking with one of our caring and knowledgeable licensed agents who are here to help you. Contact us today >>