You Can Choose a Private Alternative to Original Medicare

When you’re exploring your Medicare options in Florida and Texas, you’ll find that you can choose a Medicare Advantage (Part C) plan as a private alternative to Parts A and B. These programs can provide healthcare services that Original Medicare doesn’t cover — and sometimes for a premium as low as $0.

With that in mind, all Advantage plans have certain rules that you must follow. There are different plans that have different restrictions. Two of the most popular types of Medicare Advantage plans are HMOs and PPOs. It’s important to understand how the costs and coverage differ among these two programs, so you can determine which is right for you.

What Are Medicare HMOs?

Medicare beneficiaries in Florida can access their services through health maintenance organizations (HMOs). The insurance company contracts with specific doctors and physicians in your area to create a network. When you join a Medicare HMO, you’re agreeing to get your care through the plan’s network unless it’s an emergency situation. If you use a provider that is out of network, you typically pay the full cost of services on your own.

A primary care physician (PCP) will coordinate your healthcare and refer you to specialists. If your current physician isn’t part of the plan’s network, consider switching to another doctor. Since you must use health services within a certain network, HMO plans might not be available in some regions.

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What Are Medicare PPOs?

Like an HMO plan, a preferred provider organization (PPO) plan has a network of providers. You can go to any Medicare-approved provider you want, but it costs less to stay in the network and use a preferred provider.

However, Medicare PPOs give you more flexibility than HMOs. You don’t need a PCP and can coordinate your own healthcare services. Most of the time, you don’t need a referral to see a specialist. With PPO plans, you have a larger choice of providers — which makes PPOs widely available in most locations.

HMO and PPO Comparison Chart

Both HMOs and PPOs use a network of healthcare service providers. The primary difference is how you, the policyholder, can use the networks. 

Both types of plans may also cover additional services, such as dental, vision, and hearing. Additional benefits may increase your premium or other out-of-pocket expenses. Here’s a comparison chart to help:

** Important Note: If you enroll in an HMO or PPO, you can’t sign up for a separate prescription drug plan. Make sure your plan includes drug coverage if you need it.

Which Plan Is Right for You?

If you want a little more freedom and like the idea of being able to guide your own care, a PPO plan may be a great fit for you.

If you want to pay lower premiums and like the thought of your care being more managed, then an HMO may be a good option for you. 

Each plan type has its pros and cons. You should consider which type would be best for your needs, location, and budget when searching for an HMO or PPO plan. 

Lacayo Group Insurance Can Help

Choosing a Medicare Advantage plan is an individual decision. The right plan for your neighbor or relative may not be the right choice for you. If you’re interested in joining a PPO or an HMO, but can’t decide which option is best, reach out to Lacayo Group Insurance today. 

We specialize in Florida and Texas Medicare products. And we can help you consider variables that are specific to your situation, like whether your doctor is in the network and if the plan has a prescription drug formulary that lists your medications.