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HMO vs. PPO – Which plan is right for me?

As you may know, there are many Medicare plans out there. At RetireMed, we help you navigate through your options and choose the plan that meets your needs. One type of Medicare plan you may have heard about is Medicare Advantage, or MA plans. Because Medicare typically only covers about 80% of medical costs, most people who enroll in Medicare also purchase additional plans, like an MA plan. The two most common types of Medicare Advantage plans are HMO (health maintenance organization) and PPO (preferred provider organization) plans.

Learn more about Medicare Advantage and other kinds of Medicare plans.

HMO Plans

  • Most HMO plans include both medical and prescription coverage.
  • HMO plans use networks of providers (doctors and hospitals). You must use providers in the plan’s network in order to be covered. However, emergency or urgent care will always be covered.
  • The premiums vary, but there are many HMO plans that have $0 monthly premiums.
  • Most HMO plans require referrals from your primary care doctor to see a specialist.

PPO Plans

  • Most PPO plans include both medical and prescription coverage.
  • PPO plans also use networks of providers; however, they give you the freedom to use out-of-network providers, but you will have to pay higher copays/coinsurances and sometimes must satisfy a deductible if you go outside of your network.
  • They have “extended” networks, which may be available to you in other states. So if you travel a lot, these plans might be worth considering.
  • Most PPO plans have a monthly premium. Generally, the PPO plan premiums are higher than their HMO counterparts.
  • PPOs do not require referrals to see specialists.

Which one is right for me?

HMO and PPO plans have a lot in common and one is not better or worse than another. It all comes down to your individual needs and budget. By looking at your specific circumstances, we can assist you in choosing the right Medicare Advantage plan for you.

To learn more about Medicare Advantage plans, please contact us at 877.222.1942 or

If you are not a RetireMed client yet and have questions about retirement or Medicare, please contact us at 937.915.3563or to get started on your Medicare journey.