Medicare Advantage HMO vs PPO: what is the difference?
Written by the My Plan Compass team. Last reviewed October 29, 2026, against Medicare.gov.
The main difference is the network. In a Medicare Advantage HMO you generally must use the plan's doctors and hospitals, and you usually need a referral to see a specialist. In a PPO you can see doctors outside the network without a referral, but you usually pay more when you do. Both cover emergency and urgent care anywhere.
Side by side
| Question | HMO | PPO |
|---|---|---|
| Doctors outside the network | Generally not covered. You may have to pay the full cost. | Covered, but you usually pay more. |
| Referral to see a specialist | Usually needed. | Not needed. |
| Emergency and urgent care | Covered, in or out of network. | Covered, in or out of network. |
| Drug coverage | Included in most HMOs. | Included in most PPOs. |
Sources: Medicare.gov: HMO plans and Medicare.gov: PPO plans.
Things people miss
- HMO emergencies are covered. The network rule does not apply to emergency care, urgent care while you are away from home, or dialysis while you are temporarily out of the area.
- Some HMOs cover some care outside the network. An HMO with a Point-of-Service option (HMO-POS) may, for a higher copay or coinsurance.
- A PPO's out-of-network care has its own limit. PPOs often have a separate, higher yearly out-of-pocket limit for care outside the network. Check both.
- No drug coverage means no add-on. If you join an HMO without drug coverage, you cannot add a separate Medicare drug plan.
- Ask the plan first. Before you see a doctor outside a PPO's network, Medicare suggests checking with the plan that the care is covered.
Which fits you
If all your doctors are in a plan's network and you mostly get care close to home, an HMO's network rules may not limit you much. If you want to keep a doctor who is outside the network, or you spend part of the year away, a PPO gives you more room, at a price. Either way, the deciding question is whether your own doctors are in the network. How to check.
In My Plan Compass you add your doctors once, and we check each one against every plan, HMO and PPO alike. More in how we compare plans.
This guide is general information, not advice about your situation. We are not connected with or endorsed by the U.S. government or the federal Medicare program.