What’s the difference between a Medicare Advantage PPO and HMO?



HMO (Health Maintenance Organization)

You choose a personal doctor (also known as a PCP or primary care provider).

They must approve all visits with a specialist and all testing, but not all medications—your specialist can still prescribe them without your PCP’s approval.

You can only go to a specialist or hospital that is “in-network.” That is, on the list of approved doctors and facilities.



PPO (Preferred Provider Organization)

You’re not required to have a PCP, unless you want one.

You can go to any doctor at any time—you don’t need your PCP’s say so.

The number of different specialists and facilities you can go to is much greater.



There are other differences, but those are the big ones.