What is the main difference between HMO and PPO plans in Medicare Advantage?

The main difference between HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans in Medicare Advantage is that HMO plans typically require members to use a network of providers to receive covered services. This structure means that if an individual chooses to go outside of the network, they may not have coverage or may face significantly higher costs. Conversely, PPO plans offer more flexibility by allowing members to see any healthcare provider without requiring referrals, regardless of whether the provider is within the network. While staying in-network generally results in lower costs for PPO members, they still retain the option to seek care from out-of-network providers if they choose to do so. This distinction can significantly influence a member’s choice based on their preferences for provider access and potential cost-saving strategies.