What is the difference between HMO and PPO Medicare Advantage plans?
Last updated Jul 21, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
An HMO Medicare Advantage plan generally covers only care from doctors, hospitals, and pharmacies in its network, usually requires you to choose a primary care physician, and typically requires referrals to see specialists — with emergency and urgent care as the main out-of-network exceptions. A PPO Medicare Advantage plan covers both in- and out-of-network care (at a higher cost out of network), does not require a primary care physician or referrals, and gives you broader provider choice. Both plan types must cover everything Original Medicare covers.
Also asked as
- What is the difference between HMO and PPO Medicare Advantage plans — plain answer
- Definition of the difference between HMO and PPO Medicare Advantage plans.
What it means
- HMOs typically have lower premiums but stricter network rules.
- PPOs typically have higher premiums but out-of-network flexibility.
- Both must include emergency and urgent care nationwide and must cover every Part A and Part B service Original Medicare covers.
Action steps
- Check the plan's provider directory for every doctor you want to keep before choosing.
- Compare in-network and combined MOOPs on Medicare Plan Finder — PPOs have a separate, higher combined MOOP.
- If you travel often, the PPO's out-of-network coverage may matter more than a lower HMO premium.
Risks & deadlines
- Out-of-network care in an HMO (outside emergencies) is generally not covered — you may owe 100%.
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Last verified: 2026-07-21