Original Medicare (Parts A & B) provides coverage for hospital insurance (Part A) that cover inpatient hospital stays, skilled nursing facility care, and hospice, while medical insurance (Part B) covers doctor visits, outpatient care, preventive services, and medical supplies. This insurance plan lacks prescription drugs and additional coverage for dental, vision, and hearing aids.
Medicare Advantage (Part C) is an excellent alternative to Original Medicare, offering beneficiaries comprehensive coverage options under one plan.
There are many types of Medicare Advantage plans, including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
HMO and PPO plans both rely on in-network professionals. However, PPOs cover out-of-network professionals, and you incur relatively higher costs.
Take a look at the difference between these two plans, how they work, availability, coverage, and more.
Types of Medicare Advantage Plans
About five types of Medicare Advantage Plans are available. You can enroll in any of the following plans depending on your healthcare needs.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
- Medical Savings Accounts (MSAs)
As of 2024, approximately 32.8 million people are enrolled in Medicare Advantage plans, accounting for 54% of the eligible Medicare population. Among these enrollees, 56% are in Health Maintenance Organization (HMO) plans, while 43% are enrolled in Preferred Provider Organization (PPO) plans.
Let’s figure out the difference between these two popular plans and their offerings.
- Health Maintenance Organizations (HMOs)
In-network provider, typically called an HMO provider, is an approved healthcare expert within the plan’s network
In this plan, care is received from a doctor, healthcare provider, or hospital within the network of your chosen plan.
In emergencies, beneficiaries require pre-authorization or referral from their primary healthcare provider to consult another specialist outside their network.
HMO plans mostly include prescription drug coverage. However, these plans lack flexibility as seeking out-of-network care requires pre-authorization. Plus, you incur higher costs when seeking out-of-network care.
Coverage
HMO plans cover all the basic services of a Medicare Advantage plan. This includes dental care, vision care, gym memberships, hearing aid coverage, etc.
Costs
Medicare Advantage HMO plans include the monthly plan and Part B premiums, deductibles, copayments, and coinsurance. These plans also have a yearly out-of-pocket maximum on costs.
Some plans charge a premium in addition to the monthly Part B premium. You don’t have to manage any additional costs for seeking in-network services. However, in emergencies, you must pay additional costs.
- Preferred Provider Organizations (PPOs)
PPO, another type of Medicare Advantage Plan, allows you to receive medical care from both in-network and out-of-network providers. This plan doesn’t restrict you to your primary care doctor. Also, you’re not obligated to use your primary care doctor, but you incur relatively lower costs for medical experts and hospitals within the plan’s network.
In a PPO plan, you don’t require a referral from your primary care physician to consult physicians outside your network.
Coverage
Medicare PPO plans cover all the basic services of a Medicare Advantage plan, including hospital insurance (Part A), medical insurance (Part B), and prescription drug coverage (Part D). Some plans provide dental, vision, and hearing coverage too.
Costs
PPO plans are flexible as you’re not restricted to your primary care doctor, but out-of-network services come at a higher cost.
You pay less for in-network professionals and more for out-of-network professionals. The cost breakdown is as follows:
- Plan-specific premium: The average monthly plan premium for Medicare Advantage is $17 a month in 2025.
- Medicare Part B premium: In 2025, Medicare Part B premiums are $185 per month.
- In-network deductible: Variable cost ranging from $0 to $500 or more, depending on your plan.
- Copayments: Depend on in-network or out-of-network care.
- Coinsurance: After you meet your deductible, this fee is generally 20% of your Medicare-approved expenses.
A Comprehensive Comparison: HMO vs PPO
Take a look at the basic differences here.
| Factors | HMO | PPO |
| Premium Is there a monthly premium? | Yes, some plans charge a premium in addition to the monthly Part B premium. | Yes, some plans charge a premium in addition to the monthly Part B premium. |
| DrugsIs Drug Coverage included? | Usually yes. If your HMO doesn’t offer drug coverage, you cannot get a separate drug plan. | Usually yes. If your PPO doesn’t offer drug coverage, you cannot get a separate drug plan. |
| ProvidersCan you use any doctor/hospital that accepts Medicare? | You generally receive your care from in-network providers. | Yes. You can receive care from in-network and out-of-network providers. Out-of-network providers cost more. |
| ReferralDo you need a referral to see a specialist? | Yes | No |
Compare Plans With Silveredge Advisors
A thorough comparison of the two popular Medicare Advantage plans is necessary before you enroll in a plan.
If you need assistance comparing Medicare Advantage Plans in your State, Silveredge can provide you with comprehensive guidance and counseling regarding the available plans in your region and what they offer to beneficiaries. You can also learn about the available plans, their costs, coverage, and more.
Don’t leave your Medicare choices to chance. Connect with Silveredge Advisors today and get the personalized support you need to select a plan that works best for you. Your health is your choice — let Silveredge make it easier.
