Medicare Advantage (Part C) is a broad category of policies that are the alternative to Original Medicare plans. Because there are different Part C policies, beneficiaries have a choice between them. Which policy an individual picks will depend on a few different factors, so it’s important to learn about the details of each policy so that you can make an educated decision.


Health Maintenance Organization (HMO) policies are within the realm of Medicare Advantage. They’re similar to PPOs, but there are a few defining characteristics that are important when examining these two options. Being able to differentiate between these two is important, as one policy is often better for individuals than the other. If you’re having trouble seeing the differences between these two options, don’t hesitate to reach out to an insurance professional that can provide you with more information.

HMO policies are fairly strict about seeking care within the network. While beneficiaries do have the option to go out-of-network for care, they may need to cover the entirety of those costs out-of-pocket. Some emergency situations may be exempt from network coverage.

HMOs do require that beneficiaries get a referral in order to get care from a medical specialist. Because of that, beneficiaries are asked to select a primary care doctor. They’ll be the first point of contact in non-emergency situations and can provide you with a referral if needed.


Preferred Provider Organization (PPO) policies include network coverage and are different from HMO plans. Each PPO will have a list of providers that are within the network. Beneficiaries are encouraged to seek care from those medical providers and doing so will limit the amount that they owe. However, you can still choose to receive your care out-of-network, but just expect to pay more out-of-pocket.

PPO plans typically do not ask beneficiaries to select a primary care doctor. One of the main reasons for this is because PPOs do not require a referral when seeing a specialist. This is a huge benefit, as it can save both time and money. Not needing to see a doctor to get a specialist can eliminate a step and make it simpler if you need to visit a specialist for medical care.

Work with a Medicare professional

Selecting and enrolling in a Medicare policy is a big decision. One of the things that can make this process easier is working with a licensed insurance agent. So, reach out to Coastal Insurance Planning today to get the Medicare coverage you deserve!