Medicare Advantage Plans PPO vs HMO Which type is better?

Jul 17, 2023


What is a Medicare Advantage Plan

Understanding Medicare & it's Parts

understanding medicare part B

Curious about Medicare Advantage plans? Well, let me break it down for you. These bad boys let you get all the perks of original Medicare, but through a private insurance company. It’s like getting the best of both worlds! These plans have been around since the 70s, but they really stepped up their game in 2003 by covering Medicare part D. And guess what? Many of these plans even throw in some extras like silver sneakers, dental, vision, and hearing benefits. Plus, here’s a game-changer: they have this thing called maximum out of pocket limits. Say goodbye to those crazy medical bills, because these limits have you covered. It’s like the safety net you never knew you needed. Meanwhile, original Medicare doesn’t offer anything like that. They haven’t addressed this issue of unlimited out of pocket. So, if you’re craving some extra perks and a little piece of mind, check out Medicare Advantage plans. Trust me, you’ll be glad you did. It truly depends where you live, some areas have some amazing plans offered while other counties the complete opposite.


What is  a Medicare Advantage PPO Plan


PPO style of provider networks allow you to see any doctor that accepts Medicare but they do also have a list of preferred providers where you will usually get the best value when using your plan. PPO plans do not require you to get referrals when seeing specialists and you do not have to have a primary care doctor elected. Medicare Advantage PPO plans do usually give you more flexibility and generally larger provider networks. Typically PPO plans do not offer cost sharing as low as most HMO plans and they usually do not offer as many extras like dental, vision ect.


What is a Medicare Advantage HMO


HMO stands for health maintenance organization, this type of provider network unlike PPO’s only allow in network coverage, except for emergencies. So plain and simple, if you go to see a doctor who is not in the network you will be responsible for 100% of the cost unless it is considered an emergency. HMO style plans have a rule that you must have a primary care doctor and some insist you get referrals from that primary care doctor to see a specialist. They used to call the primary care doctors gate keepers since you needed referrals from them to get tests and see other specialists. Typically Medicare HMO plans have lower out of pocket copays and cost sharing than a PPO network. HMO plans typically offer more extras like gym memberships, dental, vision, hearing, over the counter cards and more. 



Medicare Advantage plans can be an excellent way to get all your health care needs taken care of with one comprehensive package. They offer a wide range of coverage options, from low-cost HMO plans to comprehensive PPO plans. Ultimately, which type of plan you go with depends on your own personal needs and budget as well as what’s available in your area. You would benefit greatly from speaking with an independent broker or agent in order to get the lay of the land and to make sure you understand what each plan offers. They can provide free consultations and let you see plan comparisons side by side so that you can determine which one is right for you. At our organization, we work with all the major medical carriers and have helped thousands of Medicare clients since 2007 chose the best plan for them. Don’t hesitate any longer, call us today at 631-358-5793 and get the answers to all your Medicare questions.