HMO vs. PPO Plans: What’s The Difference?

iHealthcareAugust 18, 2021

Medicare Advantage is a type of policy that exists within Medicare. These policies are offered through private insurance companies and allow individuals to add additional coverage areas to their policies that would not otherwise be available with Original Medicare.

There are a few different policy choices within Medicare Advantage. One of the important things to note is that they offer network coverage. How strict the policy is about seeking care within the network is the biggest differentiator between the different types of plans. Let’s discuss the differences between HMO policies and PPO policies.


Health Maintenance Organization (HMO) plans are the stricter option when it comes to selecting policies. They typically will only cover care if it’s within their provider network, but there are a few exceptions to this. Another defining feature of this type of policy is that it does require beneficiaries to select a primary care doctor. One of the reasons for this is that HMOs do require beneficiaries to get a referral to receive care from a specialist. The primary care doctor that’s chosen can also be helpful when keeping track of health and acting as the first line of contact in some medical situations.

HMO policies are an excellent choice if you’re confident that you’ll only ever be receiving care within the network. If you’re looking for a more flexible option, then consider if a PPO could be the right choice for you.


Preferred Provider Organization (PPO) plans are a good alternative to HMOs. They will cover care that’s received outside of the network, although you will have to pay more out-of-pocket if you do receive care outside of a network. This type of policy does not require beneficiaries to choose a primary care doctor, as it also does not require referrals to see a specialist.

Which policy is the right choice for you?

When it comes to selecting the right policy, there are so many different variables that can come into play. It can be helpful to take a look at the network in your area to get an idea of the providers that you may be receiving care from. Making sure that you’re comfortable with this list is an important step in selecting the right policy.

If you’re looking for a policy that will provide you with flexibility, then consider if a PPO could be the right choice for you. However, if you’d prefer to know how much of your care will be covered, then an HMO policy might be the best choice for you.

Regardless of the policy that you choose, being able to see the differences between them is essential. If you’re just beginning the research process, it can be helpful to reach out to an insurance agent. At iHealthcare, we’re here to make this process easier for you, so let our team help you get on the right path to finding Medicare Advantage coverage that works for you.

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