Health Maintenance Organization plans (HMO) and Preferred Provider Organization plans (PPO) are the most common types of Medicare Advantage plans.
Compare the points below to see if an HMO or a PPO plan is best for you.
What's the difference between HMO & PPO plans?
Choose the option based on what's most important to you:
HMO (Health Maintenance Organization)
I'm looking for coordinated care and cost savings:
An HMO is a type of Medicare Advantage plan that takes the place of Original Medicare. With an HMO plan, you must receive care from doctors and hospitals within the plan's network, except for emergency or urgent care. Prescription drug coverage is included with most of these plans.
PPO (Preferred Provider Organization)
I'm looking for flexibility and freedom of choice:
A PPO is a type of Medicare Advantage plan that takes the place of Original Medicare. With a PPO plan, you can receive care within a network of doctors and hospitals or use out-of-network doctors and hospitals for covered services, usually for a higher cost. Prescription drug coverage is included with most plans.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B Premium.
Out-of-network/non-contracted providers are under no obligation to treat BlueShield of Northeastern New York members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
BlueShield of Northeastern New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal.
Content Last Updated March 17, 2017