A PPO Preferred Provider Organization plan is typically a Medicare Advantage (Part C) Plan offered by Private Insurance Companies. PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. On the same thought, you pay more if you use doctors, hospitals, and providers that are outside the network.

An HMO Health Maintenance Organization plan is a Medicare Advantage Plan (Part C) that is also offered by Private Insurance Companies. In deciding to use an HMO, check in advance if your primary care physician is listed as part of the network providers. HMO Plans have network doctors, other health care providers, and hospitals in their network. Generally, you must get your care from the HMO network except in certain instances such as Emergency Care, Out of Area Urgent Care, Out of Area Dialysis. Some plans will allow you to go out of network for certain services but as a rule of thumb, it costs much less to stay in-network. Your licensed and trained representative can help you with choices to evaluate whether an HMO or PPO is best for your needs.

What is a network? A network when talking about Medicare Advantage Plans is certain facilities such as hospitals, clinics, doctors, and other healthcare providers that the Medicare Advantage Plan has contracted with to provide health care services. Each plan has a different type and has a different network to choose from however, many providers are overlapping on each network.

Benefit with using a PPO plan—Generally, in most cases, you can get your health care from any doctor, other health care provider, or hospital in PPO Plans. Each plan gives you the flexibility to go to doctors, specialists, or hospitals that aren’t on the plan’s list, but it will usually cost more.

Benefit with using an HMO plan—in most cases but not all your health care is less expensive than using a PPO. If your advisor checked to see if your physician is in the network, you should not notice any difference using an HMO. HMOs normally require a referral if you are needing to see a specialist that is not in the network. If your doctor or healthcare provider leaves the network, you will be informed and you can choose another doctor inside the plan.

NOTE: It is extremely important to follow the plan’s rules, for example getting prior approval for a certain specialty service if your doctor deems it necessary.