There are several differences in costs and coverage among Original Medicare, Preferred Provider Organizations (PPOs), and Health Maintenance Organizations (HMOs). The table below compares these three types of Medicare plans. If you are interested in joining a PPO, make sure to speak to a plan representative for more information.
|Original Medicare||Medicare PPO||Medicare HMO|
|See any provider and use any facility that accepts Medicare (participating or non-participating)||See any provider, but generally pay more when seeing out-of-network providers||See only in-network providers|
|Visit doctors anywhere in the U.S.||Visit doctors anywhere in the U.S., but generally pay more when seeing out-of-network providers||Visit doctors only in your plan’s service area, except in emergencies or when care is urgently needed|
|Do not need referrals for specialists||Do not need referrals for specialists||Typically need referrals for specialists|
|Does not cover vision, hearing, or dental services||May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs)||May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs)|
|Sign up for a stand-alone prescription drug plan (Part D)||In most cases, plan provides prescription drug coverage (you may be required to pay higher premium)||In most cases, plan provides prescription drug coverage (you may be required to pay higher premium)|
|Charged for standardized Part A and Part B costs (premiums and other cost-sharing for Part D vary depending on plan)||Generally charged higher monthly premiums than in HMOs (usually pay a copayment for in-network care and a coinsurance for out-of-network care)||Cost-sharing varies depending on plan|
|No out-of-pocket limit||Annual out-of-pocket limits for in-network care and combined in-network and out-of-network care (varies by plan)||Annual out-of-pocket limit for in-network care (maximum is $6,700 in 2020)|
Remember, if you enroll in an HMO or PPO you cannot sign up for stand-alone prescription drug coverage. Make sure your plan provides Part D coverage if you need it.
If you have Original Medicare, you also have the choice to purchase a supplemental insurance policy, or Medigap. Medigap plans cover Medicare cost-sharing and offer other benefits, but charge an additional premium. You cannot enroll in a Medigap plan if you have Medicare Advantage.
Return to: Medicare Advantage
This content was created and copyrighted by the Medicare Rights Center ©2021. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.
YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.