Medicare Advantage Plans

The important difference between them is where you can get covered treatment. A Preferred Provider Organization has what is commonly referred to as a network of coverage. This means that there is a network of preferred facilities and physicians that are pre-approved for coverage with your plan. As long as you stay within this network, you will not incur any unexpected costs from covered procedures and examinations.

A Health maintenance Organization operates in a slightly different way. HMOs also have a network of pre-approved service providers that will be covered within your plan, however the one main difference is that you must elect a primary care physician. This primary care physician acts as your personal doctor, but also as your health care coordinator. If you ever needed to see a specialty doctor who was not in your HMO plan network, your primary care physician could offer you a referral if they deemed it necessary. With this referral, your insurance will cover a share of the costs but without it you can expect to pay full price. By knowing what doctors are important to your healthcare, you can make a much more informed decision about what plan will serve you best.