Change Healthcare data breach

We are aware Change Healthcare has confirmed data was compromised in its February cyber incident.

Highmark is working with Change and United HealthGroup to fully understand the nature and extent of the impact on our members and customers. We will continue to support our members as more information becomes available.

senior male and female looking at the difference between medicare ppo and hmo

Medicare PPO vs. Medicare HMO: Which one is right for you?

Medicare Advantage plans come in a variety of types — two of the most common are PPO and HMO. Both types of plans offer different network and cost options.

Once you learn more about each plan type and how they work, it’ll be easier to choose the plan that’s right for you.

What do PPO and HMO mean?

  • PPO stands for preferred provider organization.
  • HMO stands for health maintenance organization.

Medicare PPO and Medicare HMO plans use a network of physicians, hospitals, and other health care professionals to give you the highest quality care. The difference between them is the way you interact with those networks.

What are the differences between PPO and HMO plans?

The biggest differences between PPO and HMO plans are network and cost. Let’s break it down for you.

With a PPO plan:

You don’t need a primary care physician. You can go to any provider you want without a referral — in or out of your network.  The extra coverage and flexibility you get from a PPO means that these plans will typically have higher monthly premiums. Out-of-pocket costs can also run higher with a PPO plan, too.

With an HMO plan:

Typically, you’ll have lower monthly premiums and referrals are not needed. You can expect to pay fewer out-of-pocket costs, but you’re limited when it comes to which doctors you can see. HMO plans don't cover out-of-network care.

Which one is right for me?

The decision should be about what’s most important to you.

Medicare PPO may be right for you if:

  • You’re looking for more flexibility in the doctors you see.
  • You don’t mind paying a little more for a plan with a larger network.   

Medicare HMO may be right for you if:

  • You like lower costs and don’t mind receiving care from a specific network of doctors.
  • The doctors you want to see are in the network.

Choosing the right Medicare Managed Care Plans

Find out more about the difference in Medicare Managed Care plans, such as a Medicare HMO and a Medicare PPO plan and which gives you more benefits for the money.