Understanding the Variations between Medicare Advantage HMO and PPO
Medicare Advantage: another way to get your Medicare benefits
The Medicare Advantage Program (PartC) gives you another way to get your Part A policy (hospital insurance) andPart B policy (health insurance) benefits from Original Medicare. (However,Part A continues to directly insure palliative care services). You can chooseamong several private insurance companies eligible for Medicare that offer 2019 Medicare Advantage plans where you live. You can also choose from availableMedicare Advantage policies. Two common types are the Medicare AdvantagePreferred Provider Organizations and the Medicare Advantage Health MaintenanceOrganizations. It is important to understand how each type of policy works whenconsidering options for Medicare insurance.
How are Medicare Advantage PPOs and HMOs similar?
Only source of insurance: As with all Medicare Advantage policies, Medicare Advantage HMOs and PPOs combine insurance of physician care, hospital care, and other medical services in one policy. Most Medicare Advantage HMOs and PPOs also offer insurance for Medicare Part D prescription drugs. Some policies provide routine vision and hearing insurance, dental or physical benefits that are not insured by the original Part A and B of Medicare.
Network of participating health providers: Medicare Advantage PPO and HMO policies have a network of health care providers who are participating. These networks of hospital providers, doctors and other health professionals and providers are fundamental to the way in which policies provide insurance and access to care.
When Medicare Advantage PPO and HMO establish networking policies, they generally have contracts with hospitals, doctors and other health professionals to provide members with coordinated care at a price that may be lower than the providers’ standard rates. To get the most out of your Medicare Advantage PPO or HMO policy, you should normally select the doctors and hospitals that participate in the policy’s network. If you choose a Medicare Advantage PPO or HMO policy with Medicare Medicines insurance, you can use the participating retail pharmacies and the mail order pharmacy policy network.
Defined service areas: For Medicare Advantage PPOs and HMOs, there are certain service areas that can vary in size from county to state or geographic region in the United States. In general, the service area of the Medicare HMO or PPO policy is defined by the locations of participating providers to ensure that policy members have adequate access to health services and insurance. Medicare Advantage PPO and HMO policies can only provide benefits to people in your service area. These service areas differ from one policy to another, just as the networks of their providers may be different. Therefore, you may want to make sure you are seeing the Medicare Advantage PPO and HMO policies that are available at your place of residence.
Performance and cost sharing insurance: All types of Medicare Advantage policies must insure at least the same benefits as Original Medicare (an exception here is Hospice Care, as it is still insured by Medicare Part A). PPO and HMO policies have cost-sharing features that may include deductions, co payments and/or co insurance amounts.