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Updated on 1/17/2024
The Differences Between Both Plan Options
For many people, choosing the right Medicare plan comes down to two things: cost versus flexibility. In terms of plan options, that choice often means either enrolling in a HMO or enrolling in a PPO (there is also a third option, Medicare supplements, which we describe in detail below). HMO’s offer more predictable and lower out of pocket costs, but you will have to receive routine and follow up care within a specific network. PPO’s offer more flexibility to see providers both in and out of network, but you may have higher out of pocket costs - especially when receiving care outside the PPO network. Both Medicare HMO and PPO plans cover the same benefits that original Medicare covers. The distinction lies in how these benefits are delivered and whether or not there are restrictions on how you can access your Medicare benefits (for an overview of Medicare benefits, please see our Medicare 101 page).
Medicare HMO
(Health Maintenance Organization)
HMO plans tend to have lower premiums, copays, deductibles and co-insurance compared to PPO plans. The primary consideration with any HMO is determining which medical providers you can see and still be covered. When researching HMO options, you will want to make sure that not only your doctors and other medical providers you want to see accept the plan(s), but are also in the same network. Here’s an example: let’s say you enroll in “Best Medicare HMO” plan. Your primary care doctor, who accepts Best Medicare HMO plan, is in the ABC medical group network. Your specialist doctor, who also accepts Best Medicare HMO plan, is in the XYZ medical group network. In this scenario, your primary care doctor would not be able to refer you to your specialist because they are in two separate networks – even though they both accept Best Medicare HMO plan. So you may end up having to see a different specialist who is in the ABC medical group network instead. Otherwise, you could be responsible for 100% of charges if you see your original specialist. The lesson here is to make sure that both your primary care doctor and your specialist doctor(s) accept your Medicare HMO plan and are both in the same medical group network.
To find Medicare HMO plans in your area, click here.
Medicare PPO
(Preferred Provider Organization)
PPO plans offer greater flexibility to see more providers than HMO plans. However, you will most likely pay higher premiums, copays, coinsurance and other costs associated with your health care. If you are enrolled in a Medicare Advantage PPO, you can still see doctors who are out of network and be covered. However, you may be paying up to 50% of charges - which could make Medicare Advantage PPO plans unaffordable for some. One thing to be aware of is that many PPO plans have much higher annual out of pocket maximums for out-of-network charges compared to in-network (the out of pocket maximum is the most you could be financially responsible for in a given year). Needles to say, whatever Medicare plan you are considering, you will want to pay close attention to the Maximum Out of Pocket limit so that your financial responsibility is capped at an acceptable amount.
To find Medicare PPO plans in your area, click here.
A Third Option: Medicare Supplements (a.k.a. “Medigap”)
Medicare supplement plans often get confused with Medicare Advantage PPO plans. The reason for this is because both Medicare Advantage PPO plans and Medicare supplements allow greater flexibility to see medical providers compared to Medicare HMO plans. The thing to remember is that Medicare supplements are supplemental to Original Medicare Parts A & B, whereas Medicare Advantage PPO plans replace Medicare Parts A & B.
When Original Medicare was first established in 1965, it was based on a “Fee For Service” model whereby medical providers are paid a fee for particular services rendered. Original Medicare itself does not have any networks and therefore Medicare supplements do not have any networks. If a medical provider accepts Original Medicare, then they will also accept a Medicare supplement. How it works is a provider will first bill Medicare for approved services. Medicare pays its portion and the remaining balance is then transferred to the Medicare supplement - paying up to plan limits.
There are 10 standardized Medicare supplement plans that are identified by letters A through N (click here for an overview of Medicare supplement plans and benefits). Because Medicare supplement plans are standardized, the benefits within each Medicare supplement type are the same no matter which insurance company is offering it. Premiums are the only difference between Medicare supplement plans with the same letter sold by different insurance companies.
To get Medicare supplement rates in your area, click here.
HMO/PPO/Medicare Supplement Comparison Chart
Medicare Advantage
Original Medicare
Plan Features:
Medicare Advantage HMO
Medicare Advantage PPO
Medicare Supplement (a.k.a. "Medigap")
Network Restrictions
In network only
In & out of network
N/A - The only requirement is that the provider accepts Medicare
Referrals Required
Yes
No
No
Primary Care Doctor Required
Yes
No, but strongly recommended
No
Emergencies Covered In-Network
Yes
Yes
Yes
Emergencies Covered Out of Network
Yes
Yes
Yes
Non-Emergency Out of Network Patient Responsibility
100%
Up to 50%
N/A - The only requirement is that the provider accepts Medicare
Plan Service Area
Tends To Be County Specific
Could be county or region specific
Entire U.S.
Maximum Out Of Pocket Limit (a.k.a. "Patient Financial Exposure Limit")
Yes (tends to be lower than PPO)
Yes (tends to be higher than HMO)
Depends on specific Medicare supplement plan
Prescription Drug Coverage (Part D)
* Most plans have prescription drug coverage. See plan summary of benefits.
* Most plans have prescription drug coverage. See plan summary of benefits.
No - a standalone Part D drug plan would also need to be purchased to go along with a Medicare supplement.
* Medicare Advantage plans that do not have Part D coverage are typically designed for people who have both Medicare and VA drug coverage.
Medigap or Medicare Advantage? Find out which plan option is best for you by answering these quick questions:
Or Contact Us here. It's free and there's never any obligation!
Updated on 1/17/2024
The Differences Between Both Plan Options
For many people, choosing the right Medicare plan comes down to two things: cost versus flexibility. In terms of plan options, that choice often means either enrolling in a HMO or enrolling in a PPO (there is also a third option, Medicare supplements, which we describe in detail below). HMO’s offer more predictable and lower out of pocket costs, but you will have to receive routine and follow up care within a specific network. PPO’s offer more flexibility to see providers both in and out of network, but you may have higher out of pocket costs - especially when receiving care outside the PPO network. Both Medicare HMO and PPO plans cover the same benefits that original Medicare covers. The distinction lies in how these benefits are delivered and whether or not there are restrictions on how you can access your Medicare benefits (for an overview of Medicare benefits, please see our Medicare 101 page).
Medicare HMO
(Health Maintenance Organization)
HMO plans tend to have lower premiums, copays, deductibles and co-insurance compared to PPO plans. The primary consideration with any HMO is determining which medical providers you can see and still be covered. When researching HMO options, you will want to make sure that not only your doctors and other medical providers you want to see accept the plan(s), but are also in the same network. Here’s an example: let’s say you enroll in “Best Medicare HMO” plan. Your primary care doctor, who accepts Best Medicare HMO plan, is in the ABC medical group network. Your specialist doctor, who also accepts Best Medicare HMO plan, is in the XYZ medical group network. In this scenario, your primary care doctor would not be able to refer you to your specialist because they are in two separate networks – even though they both accept Best Medicare HMO plan. So you may end up having to see a different specialist who is in the ABC medical group network instead. Otherwise, you could be responsible for 100% of charges if you see your original specialist. The lesson here is to make sure that both your primary care doctor and your specialist doctor(s) accept your Medicare HMO plan and are both in the same medical group network.
To find Medicare HMO plans in your area, tap here.
Medicare PPO
(Preferred Provider Organization)
PPO plans offer greater flexibility to see more providers than HMO plans. However, you will most likely pay higher premiums, copays, coinsurance and other costs associated with your health care. If you are enrolled in a Medicare Advantage PPO, you can still see doctors who are out of network and be covered. However, you may be paying up to 50% of charges - which could make Medicare Advantage PPO plans unaffordable for some. One thing to be aware of is that many PPO plans have much higher annual out of pocket maximums for out-of-network charges compared to in-network (the out of pocket maximum is the most you could be financially responsible for in a given year). Needles to say, whatever Medicare plan you are considering, you will want to pay close attention to the Maximum Out of Pocket limit so that your financial responsibility is capped at an acceptable amount.
To find Medicare PPO plans in your area, tap here.
A Third Option: Medicare Supplements (a.k.a. “Medigap”)
Medicare supplement plans often get confused with Medicare Advantage PPO plans. The reason for this is because both Medicare Advantage PPO plans and Medicare supplements allow greater flexibility to see medical providers compared to Medicare HMO plans. The thing to remember is that Medicare supplements are supplemental to Original Medicare Parts A & B, whereas Medicare Advantage PPO plans replace Medicare Parts A & B.
When Original Medicare was first established in 1965, it was based on a “Fee For Service” model whereby medical providers are paid a fee for particular services rendered. Original Medicare itself does not have any networks and therefore Medicare supplements do not have any networks. If a medical provider accepts Original Medicare, then they will also accept a Medicare supplement. How it works is a provider will first bill Medicare for approved services. Medicare pays its portion and the remaining balance is then transferred to the Medicare supplement - paying up to plan limits.
There are 10 standardized Medicare supplement plans that are identified by letters A through N (tap here for an overview of Medicare supplement plans and benefits). Because Medicare supplement plans are standardized, the benefits within each Medicare supplement type are the same no matter which insurance company is offering it. Premiums are the only difference between Medicare supplement plans with the same letter sold by different insurance companies.
To get Medicare supplement rates in your area, tap here.
HMO/PPO/Medicare Supplement Comparison Chart
Medicare Advantage
Original Medicare
Plan Features:
Medicare Advantage HMO
Medicare Advantage PPO
Medicare Supplement (a.k.a. "Medigap")
Network Restrictions
In network only
In & out of network
N/A - The only requirement is that the provider accepts Medicare
Referrals Required
Yes
No
No
Primary Care Doctor Required
Yes
No, but strongly recommended
No
Emergencies Covered In-Network
Yes
Yes
Yes
Emergencies Covered Out of Network
Yes
Yes
Yes
Non-Emergency Out of Network Patient Responsibility
100%
Up to 50%
N/A - The only requirement is that the provider accepts Medicare
Plan Service Area
Tends To Be County Specific
Could be county or region specific
Entire U.S.
Maximum Out Of Pocket Limit (a.k.a. "Patient Financial Exposure Limit")
Yes (tends to be lower than PPO)
Yes (tends to be higher than HMO)
Depends on specific Medicare supplement plan
Prescription Drug Coverage (Part D)
* Most plans have prescription drug coverage. See plan summary of benefits.
* Most plans have prescription drug coverage. See plan summary of benefits.
No - a standalone Part D drug plan would also need to be purchased to go along with a Medicare supplement.
* Medicare Advantage plans that do not have Part D coverage are typically designed for people who have both Medicare and VA drug coverage.
Medigap or Medicare Advantage? Find out which plan option is best for you by answering these quick questions:
Or Contact Us here. It's free and there's never any obligation!
Updated on 1/17/2024
The Differences Between Both Plan Options
For many people, choosing the right Medicare plan comes down to two things: cost versus flexibility. In terms of plan options, that choice often means either enrolling in a HMO or enrolling in a PPO (there is also a third option, Medicare supplements, which we describe in detail below). HMO’s offer more predictable and lower out of pocket costs, but you will have to receive routine and follow up care within a specific network. PPO’s offer more flexibility to see providers both in and out of network, but you may have higher out of pocket costs - especially when receiving care outside the PPO network. Both Medicare HMO and PPO plans cover the same benefits that original Medicare covers. The distinction lies in how these benefits are delivered and whether or not there are restrictions on how you can access your Medicare benefits (for an overview of Medicare benefits, please see our Medicare 101 page).
Medicare HMO
(Health Maintenance Organization)
HMO plans tend to have lower premiums, copays, deductibles and co-insurance compared to PPO plans. The primary consideration with any HMO is determining which medical providers you can see and still be covered. When researching HMO options, you will want to make sure that not only your doctors and other medical providers you want to see accept the plan(s), but are also in the same network. Here’s an example: let’s say you enroll in “Best Medicare HMO” plan. Your primary care doctor, who accepts Best Medicare HMO plan, is in the ABC medical group network. Your specialist doctor, who also accepts Best Medicare HMO plan, is in the XYZ medical group network. In this scenario, your primary care doctor would not be able to refer you to your specialist because they are in two separate networks – even though they both accept Best Medicare HMO plan. So you may end up having to see a different specialist who is in the ABC medical group network instead. Otherwise, you could be responsible for 100% of charges if you see your original specialist. The lesson here is to make sure that both your primary care doctor and your specialist doctor(s) accept your Medicare HMO plan and are both in the same medical group network.
To find Medicare HMO plans in your area, tap here.
Medicare PPO
(Preferred Provider Organization)
PPO plans offer greater flexibility to see more providers than HMO plans. However, you will most likely pay higher premiums, copays, coinsurance and other costs associated with your health care. If you are enrolled in a Medicare Advantage PPO, you can still see doctors who are out of network and be covered. However, you may be paying up to 50% of charges - which could make Medicare Advantage PPO plans unaffordable for some. One thing to be aware of is that many PPO plans have much higher annual out of pocket maximums for out-of-network charges compared to in-network (the out of pocket maximum is the most you could be financially responsible for in a given year). Needles to say, whatever Medicare plan you are considering, you will want to pay close attention to the Maximum Out of Pocket limit so that your financial responsibility is capped at an acceptable amount.
To find Medicare PPO plans in your area, tap here.
A Third Option:
Medicare Supplements
(a.k.a. "Medigap")
Medicare supplement plans often get confused with Medicare Advantage PPO plans. The reason for this is because both Medicare Advantage PPO plans and Medicare supplements allow greater flexibility to see medical providers compared to Medicare HMO plans. The thing to remember is that Medicare supplements are supplemental to Original Medicare Parts A & B, whereas Medicare Advantage PPO plans replace Medicare Parts A & B.
When Original Medicare was first established in 1965, it was based on a “Fee For Service” model whereby medical providers are paid a fee for particular services rendered. Original Medicare itself does not have any networks and therefore Medicare supplements do not have any networks. If a medical provider accepts Original Medicare, then they will also accept a Medicare supplement. How it works is a provider will first bill Medicare for approved services. Medicare pays its portion and the remaining balance is then transferred to the Medicare supplement - paying up to plan limits.
There are 10 standardized Medicare supplement plans that are identified by letters A through N (tap here for an overview of Medicare supplement plans and benefits). Because Medicare supplement plans are standardized, the benefits within each Medicare supplement type are the same no matter which insurance company is offering it. Premiums are the only difference between Medicare supplement plans with the same letter sold by different insurance companies.
To get Medicare supplement rates in your area, tap here.
HMO/PPO/Medicare Supplement Comparison Chart
Find out which plan option is best for you by answering these quick questions:
Or Contact Us here. It's free and there's never an obligation to enroll!
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By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. MedicareOptions360.com is privately owned and operated by MedicareOptions360. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-877-888-6315 to determine eligibility and to request a copy of the applicable policy. MedicareOptions360.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.
By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. MedicareOptions360.com is privately owned and operated by Alderette Insurance Agency, Inc. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-877-888-6315 to determine eligibility and to request a copy of the applicable policy. MedicareOptions360.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.
© MedicareOptions360.com, a division of Alderette Insurance Agency, Inc.,
138 N Brand Blvd, Suite 200 Unit #270, Glendale, CA 91203
By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. MedicareOptions360.com is privately owned and operated by Alderette Insurance Agency, Inc. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-877-888-6315 to determine eligibility and to request a copy of the applicable policy. MedicareOptions360.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.