Is it better to have an HMO or PPO medicare plan?


Editorial team Published on

Medicare HMO plans cost less but require you to stay in a strict network, while PPO plans offer more freedom to see out-of-network doctors for a higher price.

You can review specific plan choices with the UnitedHealthcare Medicare Guide or compare options using Humana Medicare Resources.

Key Differences

  • Cost: HMOs usually feature lower monthly premiums and out-of-pocket expenses. PPOs usually charge higher premiums and higher cost-sharing.
  • Primary Care Physician (PCP): HMOs require you to pick a primary doctor. PPOs do not require a designated PCP.
  • Specialist Referrals: HMOs require a referral from your primary doctor to see a specialist. PPOs let you book a specialist directly without a referral.
  • Out-of-Network Care: HMOs do not cover non-emergency care outside their network, leaving you to pay the total cost. PPOs cover out-of-network providers, though you pay a larger share of the bill.

Which Should You Choose?

  • Choose an HMO if: You want lower monthly bills, plan to stay near your home area, and do not mind getting referrals.
  • Choose a PPO if: You travel often, want to keep a doctor who is outside the network, or prefer seeing specialists without asking for permission first.