When you join a Medicare Advantage plan (Part C), you can choose from different types of plans: Medicare HMO or Medicare PPO. Both types of plans offer network and cost options. Learn more about the difference so you can choose the one that best suits your budget and medical needs.
What is a Medicare Preferred Provider Organization (PPO) plan?
By choosing a Medicare PPO plan, you may pay less if you use doctors and hospitals in the plan’s network. PPO plans have large networks, but you can also see doctors who are out of network. Plus, you don’t need a referral to see a specialist. Anthem MediBlue PPO is a Part C plan that gives you the flexibility to see any doctor or specialist, in or out of network, without a referral.
What is a Medicare HMO (Health Maintenance Organization) plan?
When you choose a Medicare HMO plan, you get the most out of your care from a network of doctors and hospitals, barring an emergency. You may also need a referral from a GP to see a specialist. The Anthem MediBlue HMO plan has all the benefits of a Medicare Advantage plan with access to our leading network of quality doctors
Are PPO and HMO plans offered with Original Medicare?
PPO and HMO plans are only available through private insurance companies like Anthem, like Medicare Advantage plans. If you’re signing up for Medicare for the first time, you’ll need to sign up for Original Medicare first . Then you can choose a Medicare Advantage HMO or PPO plan that works for you.
Medicare PPO plan costs
PPO plans tend to have higher costs than HMO plans, and it’s more expensive to see an out-of-network doctor. You can choose a PPO plan for its flexibility.
Medicare HMO plan costs
The costs of an HMO plan are usually lower than PPO plans, as long as you receive care within the network. Choosing doctors outside the network or seeing a medical specialist without a referral from your primary care doctor will also be more expensive.
Prescription Drug Coverage by Plan Type
Depending on the plan, both types of PPO and HMO plans can offer medical and prescription drug coverage for an all-in-one plan. If you take medications regularly, be sure to find a plan that offers that coverage.
Which is better? The PPO or HMO plan?
The two types of plans offer different types of coverage based on their costs and networks, so the best plan for you depends on your budget and medical preferences.
Medicare PPO is a better choice if:
- You’re looking for more flexibility in the doctors you see.
- You don’t mind paying a little more for a plan with a larger network.
- You prefer to see a specialist or undergo medical tests without a referral.
Medicare HMO is a better choice if:
- You prefer the lowest costs and don’t mind receiving medical care from a network of doctors.
- The doctors you want to see are part of the network.
- You prefer to have a primary care physician coordinate all of your care and provide referrals for other specialists and tests.
Can I change from a Medicare HMO plan to a Medicare PPO plan?
Yes, you can change your plan type during Medicare’s annual enrollment period , from October 15 to December 7. You can also change your Medicare Advantage plan type during the Medicare open enrollment period, from January 1 to March 31. In addition, you may have a special enrollment period that is based on certain life events that affect your coverage. This special enrollment period allows you to switch to another Medicare Advantage plan if you qualify.
