Medicare HMO (Health Maintenance Organization) plans, (PPO) Preferred Provider Organization plans and POS (Point-of-Service) plans have much in common.
- Medicare HMO, PPO and POS plans are all Medicare Advantage (Part C) coordinated care plans offered by private companies.
- All Medicare Advantage plans offer the same coverage as Original Medicare (Part A and Part B), and they typically include prescription drug coverage as well. Many also offer dental, vision and hearing care, wellness programs and other health care benefits not included with Original Medicare.
- Cost and coverage offered by Medicare Advantage plans are determined by the companies offering them, so there is considerable variability among plans.
For all of their similarities, there are important differences between HMO, PPO and POS plans. Depending on your situation and your preferences, any one of them might be a good choice for you.
HMO Plans: Cost Savings and Preventive Care
HMO plans cover health care services provided within a network of contracted physicians and hospitals. Except for emergencies, these plans do not cover care received outside the network. If you have a doctor that you want to keep seeing, then it’s important to make sure that doctor is “in-network” for any HMO you’re considering. Most HMOs require you to have or choose a primary care physician (PCP) in the plan network. Your PCP provides general medical care and authorizes referrals to in-network specialists.
PPO Plans: Flexibility in Provider Choice
Similar to HMOs, Medicare Advantage PPO plans cover care and services provided by a network of physicians and hospitals. However, you can see providers outside the network for any service at any time, as long as they accept Medicare and you’re willing to pay more out-of-pocket. For example, you may receive 90% reimbursement for care received in-network and receive only 60% reimbursement for the same care provided outside the network.
POS Plans: An HMO with Some Flexibility
Like an HMO, a Medicare Advantage POS plan requires that you have or select a primary care physician from within the plan network. And like a PPO plan, you have the option of using out-of-network physicians. The difference is that this must first be approved by the plan. Unapproved out-of-network care will not be covered by the plan or by Medicare. In addition, you usually pay more for an approved out-of-network service than for the same service in-network.
To learn more, contact UnitedHealthcare® Medicare Made Clear at 1-877-619-5582 (TTY 711), 8 a.m. – 8 p.m., 7 days a week. You may also call the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
Medicare Advantage Basics
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