Medicare Advantage Plans

Medicare Advantage Plans are private insurance companies that will provide your Care rather than medicare

Health Maintenance Organizations (HMO)

HMO’s will generally will be the most cost-effective option. But there are trade-offs, especially with freedom of choice.

With HMO’s, you must receive care within the plan network (unless it’s an emergency or urgent care). 

HMO’s usually require that you use a primary care doctor (PCP). This doctor will coordinate your care with other providers, in most situations you will need a referral from your PCP before you see specialist.

Authorizations from the PCP or the Plan are required before labwork, imaging, surgeries,  hospitalizations, etc, are performed.

HMO’s may have no or low premiums but will have copay’s for most services, such as doctor visits, testings, outpatient surgeries and hospitalizations.

Preferred Provider Organizations (PPO)

PPO’s allow more freedom of choice than HMO’s. They have networks but typically do not require that you choose a  Primary Care Physician and referrals are not required. This gives you more freedom when seeking care and choosing providers.

However, you will face much higher copays or coinsurance if you go outside the network.

Many PPO plans allow you to use networks in different states, making it easier to receive non-emergency care while traveling out of your home state.

PPO plans will have higher copays for services than HMO plans. 

For some people, PPO plans are a happy medium between HMO plans and Medicare Supplements.