HMO, in general
An HMO usually requires you to use doctors and hospitals in the plan network, except in an emergency. A primary-care doctor and referrals to specialists are common. Rules vary by plan. Read the Evidence of Coverage.
PPO, in general
A PPO usually lets you see out-of-network providers at a higher cost. Referrals may not be required. Out-of-network bills can still be large. “PPO” is not the same as Original Medicare.
This is not Medigap
Medigap is not an HMO or PPO. It works with Original Medicare and typically does not use an Advantage-style network. Confusing those structures is a common source of surprise medical bills.
ZIP code still decides what exists
HMO and PPO products available to you depend on ZIP code. Medisure does not offer every plan in your area. For a complete list, visit Medicare.gov, call 1-800-MEDICARE (TTY 711), or California HICAP at 1-800-434-0222.
Common questions
- Is a PPO the same as Original Medicare?
- No. A PPO is a type of Medicare Advantage network. Original Medicare is Parts A and B, accepted by providers who take Medicare.
- Which is better — HMO or PPO?
- Neither is automatically better. Doctors, drugs, travel, and cost-sharing all matter. This website does not pick a plan.
We are not affiliated with or endorsed by the U.S. Government or the federal Medicare program. This page is general education. We do not offer every plan available in your area. Currently we represent 6 organizations which offer Medicare Advantage and Part D products in California. The number of products available to you depends on your ZIP code. For a complete list of options, visit Medicare.gov, call 1-800-MEDICARE (1-800-633-4227), TTY 711, or California HICAP at 1-800-434-0222.