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Chapter 10: Medicare Advantage Plans Part C—HMOs vs PPOs

Chapter 9: Medicare Advantage Part C

What are HMOs?

Health Maintenance Organizations (HMOs), are sold by private companies as Part C of Medicare Advantage Plans.

What is Covered?

Copayments are set by each plan and you must use network doctors and hospitals specific to your plan. Under an HMO plan, you must establish with an in-network primary care physician.

HMOs often include prescription drug coverage. Referrals to see a specialist are required.

What are PPOs?

Preferred Provider Organizations (PPOs), are sold by private companies as Part C of Medicare Advantage Plans.

What is Covered?

Copayments are set by each plan. However, unlike HMO plans, you can visit any doctor, health care provider, or hospital of your choice. Establishing with a primary care physician is not required.

PPOs often include prescription drug coverage. Referrals to see a specialist are not required.

Bottom Line: It is important to shop around and compare plans before selecting a plan that is best for you. (see chapter 12)

Chapter 11: After Enrollment