What is the difference between a Medicare Advantage PPO plan and a Medicare Advantage HMO plan?
HMO stands for Health Maintenence Organization and is a type of insurance structure that limits coverage to specific contracted medical care providers and hospitals. These are known as in-network providers or providers in the health insurance plan’s network.
Each HMO member has to have a primary care doctor (PCP) that coordinates their care. The primary care doctor will be the member’s first point of contact, and they will determine when a specialist is needed. The primary care doctor will then refer the client to the appropriate in-network specialist. Only services through doctors and other providers who are under contract with the HMO will be covered, unless it is authorized in advance by the HMO plan.
Usually, HMOs have the lowest cost-sharing for beneficiaries, making it a good option for those cost-conscious and willing to stick with the network. Some also like the advantage of having a primary care doctor coordinate and manage their care.
In case of emergency, you are allowed to go to the nearest emergency room, even if the hospital is not in-network.
What is a PPO plan?
How do max out-of-pockets work?
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