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Differences Between HMO and PPO Medicare Plans

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 8, 2026

Medicare HMOs generally require you to use in-network providers except for emergencies and urgent care, while Medicare PPOs also cover out-of-network care at a higher cost; HMOs often cost less, and PPOs give more flexibility.

For 2027 several large insurers are cutting PPOs, including UnitedHealthcare (34), Humana (37), Aetna (20) and HCSC (48), so some PPO members will need to switch plans or move to an HMO.

See changes to Medicare Advantage plans in 2027.

✔ Licensed in all 50 states
✔ Based on CMS 2027 data
✔ Free plan comparison

Key Highlights

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HMO: in-network care.

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PPO: out-of-network at higher cost.

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HMOs often cost less.

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Many PPOs cut for 2027.

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HMO vs PPO Side by Side

Feature HMO PPO
Out-of-network care Not covered except emergencies and urgent care Covered at a higher cost
Referrals for specialists Usually required Usually not required
Premiums Usually lower Usually higher
Out-of-pocket maximum In-network limit In-network limit plus a higher combined limit
Best for Lower costs, local care Flexibility, travel, keeping specific doctors

2027 PPO Cuts by Insurer

Insurer 2027 PPO Change
UnitedHealthcare Cutting 34 PPOs
Humana Cutting 37 PPOs
Aetna Cutting 20 PPOs
HCSC Cutting 48 PPOs
Kaiser Permanente Dropping its last 3 PPOs
Excellus BCBS Ending MA PPOs across its Central New York market
HealthPartners Journey Steady and Journey Stride PPOs end

Watch for: if your plan is ending, you will get a non-renewal letter. Your coverage continues through December 31, 2026. If you do nothing, you return to Original Medicare without drug coverage.

What Medicare Advantage Plans Offer

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Which Plan Type Fits You?

HMO Plans

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Usually lower premiums and copays

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Use in-network doctors except emergencies

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May need referrals for specialists

PPO Plans

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See out-of-network doctors at a higher cost

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Usually no referrals needed

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More flexibility if you travel

Questions to Ask Before Choosing

Ask These

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Are all my doctors in network?

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Do I need referrals to see specialists?

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How much more is out-of-network care in the PPO?

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Which services need prior authorization?

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What is the out-of-pocket maximum for in-network and combined care?

If Your PPO Is Ending

Step by Step

1

Read your non-renewal letter. Coverage continues through December 31, 2026.

2

Check whether an HMO includes your doctors. Many members can switch to an HMO from the same insurer.

3

Compare PPOs from other insurers. Some insurers still offer PPOs in your county.

4

Consider Medigap. In most cases you can buy certain Medigap plans under a guaranteed issue right.

Medicare Advantage HMOs and PPO Plans

How Medicare Advantage Works

Medicare Advantage, also called Part C, is a way to get your Medicare benefits through a private insurance company approved by Medicare. The plan covers everything Original Medicare Part A and Part B cover, except hospice care, which Original Medicare still pays. Most plans also include Part D drug coverage, and many may add extras such as routine dental, vision and hearing benefits.

In exchange, Medicare Advantage plans generally use networks of doctors and hospitals, and may require referrals or prior authorization for some services. Every Medicare Advantage plan has a yearly out-of-pocket maximum for covered medical care, which Original Medicare does not have. You keep paying your Part B premium, plus your plan’s premium if it has one.

How to Compare

How to Compare

1

Read your Annual Notice of Change. It lists every change to your current plan for 2027.

2

Check your doctors and hospitals. Confirm each provider is in the 2027 network, not just the 2026 one.

3

Check your prescriptions. Confirm each drug, its tier and any prior authorization or step therapy rules.

4

Compare total yearly cost. Add the premium, typical copays and drug costs, and look at the out-of-pocket maximum.

5

Check star ratings. Medicare rates plans from 1 to 5 stars on quality and service.

6

Enroll by December 7. Your new coverage starts January 1, 2027.

Enrollment Periods

Enrollment Period Dates What You Can Do
Annual Enrollment Period October 15 to December 7, 2026 Join, switch or drop a Medicare Advantage or Part D plan for January 1, 2027
Medicare Advantage Open Enrollment January 1 to March 31, 2027 If you are in Medicare Advantage, switch to another plan or return to Original Medicare once
Initial Enrollment Period 7 months around your 65th birthday month Sign up for Medicare and choose your first plan
Special Enrollment Periods Varies Change plans after events like moving, losing other coverage or your plan leaving your area

Most people make changes during Annual Enrollment. If you are happy with your current plan, you do not have to do anything; it renews automatically. Still, read your Annual Notice of Change, because premiums, copays, networks and drug lists can all change on January 1.

Reading Your Annual Notice of Change

Check Every Line

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Your 2027 premium and deductible

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Copays for doctors, specialists and hospital stays

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The out-of-pocket maximum

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Updates to your formulary, drug tiers and coverage requirements

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Whether your doctors, hospitals and pharmacy are still in network

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Changes to dental, vision, hearing and other extras

Plans must send the Annual Notice of Change by September 30. It is the single most useful document you get each fall, because it tells you exactly how your plan changes on January 1.

Special Enrollment Periods

Outside the fall and early-year windows, you generally need a Special Enrollment Period to change plans. Common reasons include:

You May Qualify If

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Your plan is leaving your area or ending

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You move outside your plan’s service area

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You lose employer or union coverage

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You qualify for Extra Help or a Medicare Savings Program, or your Medicaid status changes

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You want to join a 5-star plan, once a year

Each Special Enrollment Period has its own time limit, so act as soon as the event happens.

Prior Authorization and Referrals

Most Medicare Advantage plans require prior authorization for some services, such as certain surgeries, advanced imaging, skilled nursing stays and some drugs. Your doctor usually requests it, but ask whether a planned service needs approval so a denial does not surprise you.

If a request is denied, you or your doctor can appeal. Medicare rules set deadlines for plans to decide, with faster deadlines when waiting could seriously harm your health.

Emergency, Urgent and Out-of-Area Care

Every Medicare Advantage plan covers emergency care and urgent care anywhere in the U.S., in or out of network, and you do not need prior approval for an emergency. Routine care away from home is a different story: HMOs generally do not cover it, while PPOs cover out-of-network care at a higher cost.

If you spend months away from home each year, ask each plan how it handles care in your second location. It is one of the most common reasons people switch plans mid-year.

Appeals and Complaints

If your plan denies a service, a drug or payment for care, you have the right to appeal. The plan’s denial notice explains how. There are several levels of appeal, starting with the plan and moving to independent reviewers.

For problems that are not about coverage, such as customer service or wait times, you can file a grievance with the plan. You can also contact 1-800-MEDICARE or your State Health Insurance Assistance Program for help.

The 2027 Part B Premium

The Part B premium is the one big number not released with the plans. CMS normally announces it in November. The 2026 Medicare Trustees Report projects a 2027 standard premium of about $209.50 a month and a deductible of about $292, up from $202.90 and $283 in 2026. You keep paying it with Medicare Advantage.

Getting Help

You do not have to compare plans alone, and you should not have to pay for help. These are the free options:

Free Help Comparing Plans

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Medicare Plan Finder on Medicare.gov, available any time

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1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week

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Your State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling

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A licensed insurance agent or broker, who can compare plans from several insurers at no cost to you

Before any call, have your Medicare card, your list of drugs and doses, your doctors and your preferred pharmacies ready. It turns a long conversation into a short one.

Bottom Line

The Bottom Line

Choose an HMO if your doctors are in network and you want lower costs; choose a PPO if you need out-of-network flexibility, and confirm it continues for 2027.

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Frequently Asked Questions

➤ What is the main difference between an HMO and a PPO?

An HMO generally covers care only from in-network providers except for emergencies and urgent care, while a PPO also covers out-of-network care at a higher cost. HMOs often have lower premiums and copays than PPOs.

➤ Do I need referrals in a Medicare HMO?

Many Medicare HMOs require a referral from your primary care doctor before you see a specialist, but rules vary by plan. Check your plan’s Evidence of Coverage before booking specialist visits. Skipping a required referral can leave you with the full bill.

➤ Do Medicare PPOs require referrals?

Most Medicare PPOs do not require referrals to see specialists, which is one reason people choose them. Some services may still need prior authorization, so check plan rules before scheduling care. Out-of-network care usually costs more.

➤ Is an HMO or PPO cheaper?

HMOs often have lower premiums and copays because care stays in network. PPOs may cost more but cover out-of-network care, so compare total yearly cost, including the out-of-pocket maximum. A cheaper plan that excludes your doctors can end up costing more.

➤ Which insurers are cutting PPOs for 2027?

UnitedHealthcare is cutting 34 PPOs, Humana 37, Aetna 20 and HCSC 48 for 2027. Kaiser Permanente is dropping its last 3 PPOs, and some regional plans are ending PPOs too, so read your Annual Notice of Change.

➤ What if my PPO is ending in 2027?

You will get a non-renewal letter, and coverage continues through December 31, 2026. You can choose another plan during Annual Enrollment or a Special Enrollment Period and generally have guaranteed issue rights to certain Medigap plans.

➤ Does an HMO cover emergencies away from home?

Yes, Medicare HMOs cover emergency and urgent care anywhere in the U.S. Routine care outside the network or service area is usually not covered, so travelers should check plan rules. Keep your member card with you.

➤ Who should choose a Medicare PPO?

A PPO often fits people who see doctors in more than one network, travel within the U.S. or want to see specialists without referrals. Confirm a PPO is still offered in your county for 2027.

➤ Who should choose a Medicare HMO?

An HMO often fits people whose doctors are all in one network, who want lower costs and who are comfortable with a primary care doctor coordinating care. Check every doctor before you enroll. Networks can change yearly.

➤ Can I switch from a PPO to an HMO?

Yes, you can switch during Annual Enrollment, October 15 to December 7, 2026, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31, 2027. A plan ending also gives you a Special Enrollment Period.

Have Questions?

Speak with a licensed insurance agent

1-855-398-0716

TTY users 711

Mon-Fri: 8am-9pm ET

Find & Compare Plans Online

Speak with a licensed insurance agent

1-855-398-0716TTY 711

Mon-Fri: 8am-9pm ET

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