Most folk that have Medicare Advantage plans in this country have HMO type plans. Often with HMO Medicare Advantage plans the networks are smaller. This means that your pool of doctor’s to choose from often can be quite small, depending on where you live.  You will also need to get referrals to see specialists. A lot of people in these plans find this to be a pain in the neck.

Generally speaking, you will need referrals to see Specialists and you are not covered “out of “network”. This means if you need to see a provider who does not accept your HMO coverage, you will either have to negotiate a cash price, with that out-of-network provider or access your HMO network. Under this example, you may not be able to see the doctor you want

With PPO Medicare Advantage Plans you will have a much larger network of doctors to choose from. You DO NOT need referrals to see specialists and you are covered IN and OUT of network. If you stay in network your copays will be lower. If you go out, you’re still covered but you will have a higher copay.  In short a PPO type plan will give you greater freedoms to access care.

Now any type Of Medicare Advantage plan will cover you for emergency and urgently needed care in all 50 states and U.S. territories, regardless of whether your plan is a HMO or PPO.

If you have any questions on your coverage and would like t find out what is best for you, call me and we can go over your options and potential costs in terms of co pays on health care and prescriptions.


Medicare Dave

[email protected] or (813)417-2716