What is the difference between an HMO and a PPO?
When you are on an HMO (Health Maintenance Organization) plan, the plan typically pays charges as long as the medical services are received within the plan’s network. When you are on a PPO (Preferred Provider Organization) plan, you have the option of receiving care in the plan network or out of the network, but the plan typically pays a greater percentage when the care is in network. PPOs generally cost more than HMOs because they offer greater flexibility.
Enrollment in the 2019 Medicare Advantage plans will begin on October 15th, 2018 and will run through the Annual Enrollment Period ending on December 7th, 2018. Some of the features of typical 2018 Medicare Advantage plans can be found below.
Typical Medicare Advantage HMO Plan Example
- $0.00 Premium
- $0.00 medical deductible
- $5 or $10 doctor office visits
- $35-50 specialist office visits
- $0 for dental cleanings and oral exams every six months
- Up to $750 per year for most dental services
- $0 for one routine eye exam per year
- Up to $200 per year for contact lens or eyeglasses
- $0 for one routine hearing exam per year
- Annual hearing aid allowances
- $30-50 credit toward over-the-counter items per quarter
- $0 for fitness membership
- $0 pharmacy deductible
Typical Medicare Advantage PPO Plan Example
- $0.00 Premium
- $0.00 medical deductible
- $5 doctor office visits in network, $50 out of network
- $45 specialist office visits in network, $50 out of network
- $0 for dental cleaning every six months (in network); you pay 20% out of network
- $0 for oral exam every six months (in network); you pay 20% out of network
- Up to $750 per year for most dental services
- $0 for one routine eye exam per year in network; you pay 50% out of network
- Up to $200 per year for contact lens or eyeglasses
- $0 for one routine hearing exam per year in network; you pay 50% out of network
- $350 maximum hearing benefit per year
- $50 in over-the-counter items per quarter
- $0 for fitness membership
- $150 pharmacy deductible
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