HMO vs. Medicare Advantage PPO
Medicare Advantage is a specific type of Medicare also known as Medicare
Part C. The Medicare Advantage plan offers individuals an alternative
to Parts A and B. While Medicare Advantage is a Medicare approved program,
this health insurance is delivered through private companies.
In order to obtain Medicare Advantage, you’ll need to be entitled
to Medicare Part A and enrolled in Medicare Part B. You’ll continue
to pay the part B premium and you’ll retain all of your full Medicare
rights - but you’ll have additional benefits that aren’t part
of your Medicare coverage. Many people opt for Medicare Advantage as it
can provide stable costs for dental, vision and alternative care. Since
Medicare Parts A and B don’t offer full coverage of all health care
needs, getting additional coverage through a Medicare Advantage plan can
be a smart move.
Medicare Advantage plans come in two major varieties - HMO plans and PPO plans.
HMO plans, or health maintenance organizations, allow you to choose from a network
of contracted, reliable doctors who work exclusively with your health
plan’s members. You’ll choose a primary care physician from
the plan network and be referred to specialists within the plan network
if you need additional care. In addition to health insurance coverage,
Medicare Advantage HMO plans also include prescription drug coverage similar
to Medicare Part D coverage. Many retirees and seniors seek out HMO coverage
because of the cost savings. With a Medicare Advantage HMO plan, you’ll
be able to have all of the coverage of Medicare Part A and Medicare Part
B with your additional benefits for one low monthly premium.
Another option for Medicare Advantage health insurance coverage is a PPO plan. Preferred Provider Organizations offer care within a network of physicians
and hospitals. You can see providers outside of the network of physicians
and hospitals but you’ll be paying more out of pocket. For example,
with a Medicare Advantage HMO plan, your coverage may lead to a lower
out-of-pocket expense in comparison to the same care covered by a PPO
and using an out-of-network provider. Monthly premiums can be higher for
PPO plans as well, which can be a problem for Medicare patients on a fixed income.
Page Last Updated: 9/29/16