Ikey Fowler

There are basically two types of Medicare Advantage Plans. One type is a HMO. HMO stands for Health Maintenance Organization. The other type is a PPO or Preferred Provider Organization. Although both are Medicare Advantage Plans there are some distinct differences in the two.

In most HMO plans you generally can only go to doctors, health care facilities or hospitals that are on the provider list of the plan except in emergency. HMO plans require you to name a primary care provider (PCP). Your PCP becomes the quarterback of your health care. This means you may have to have a referral from your PCP if you want to see a specialist or another health care provider. All HMO plans do not require a referral, so this is a question you will want to ask of considering a HMO.

In a PPO plan, you also have a defined network of providers. You will pay less if you use a provider in the plan’s network but, unlike a HMO, you may have some coverage if you go to an out-of-network provider. You will pay more for using an out-of-network provider versus an in-network provider. Also a PPO plan may give you the option of getting your health care from a provider outside your immediate geographical area whereas a HMO can be more limited.

HMO and PPO plans are similar in many ways. They both have a defined network of providers, both have a copay on most services you receive and except for a few exceptions will both include prescription drug coverage. Finding a Medicare health plan is about finding the plan that is right for you. It’s a good idea to research both HMO and PPO plans if you are considering a Medicare Advantage Plan.


If you have questions regarding any aspect of Medicare or Medicare health plans feel free call us at Alabama Health Guidance (256-648-5710), stop by our office at 885 Florence Blvd (Four Lane Shopping Center) or email me at ikey@alabamahealthguidance.com.

Alabama Health Guidance is an independent insurance agency and is not affiliated with Medicare or any other government agency.