There are several differences in costs and coverage among Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , Preferred Provider Organizations (PPOs), and Health Maintenance Organizations (HMOs). The table below compares these three types of Medicare plans. If you are interested in joining a PPO, make sure to speak to a plan representative for more information.
Original Medicare |
Medicare PPO |
Medicare HMO |
See any provider and use any facility that accepts Medicare (participating or non-participating) |
See any provider, but generally pay more when seeing out-of-network providers |
See only in-network providers |
Visit doctors anywhere in the U.S. |
Visit doctors anywhere in the U.S., but generally pay more when seeing out-of-network providers |
Visit doctors only in your plan’s service area, except in emergencies or when care is urgently needed |
Do not need referrals for specialists |
Do not need referrals for specialists |
Typically need referrals for specialists |
Does not cover vision, hearing, or dental services |
May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs) |
May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs) |
Sign up for a stand-alone prescription drug plan (Part D) |
In most cases, plan provides prescription drug coverage (you may be required to pay higher premium) |
In most cases, plan provides prescription drug coverage (you may be required to pay higher premium) |
Generally charged higher monthly premiums than in HMOs (usually pay a copayment for in-network care and a coinsurance for out-of-network care) |
Cost-sharing varies depending on plan |
|
No out-of-pocket limit |
Annual out-of-pocket limits for in-network care and combined in-network and out-of-network care (varies by plan) |
Annual out-of-pocket limit for in-network care (maximum is $9,350 in 2025) |
Remember, if you enroll in an HMO or PPO you cannot sign up for stand-alone prescription drug coverage. Make sure your plan provides Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. coverage if you need it.
If you have Original Medicare, you also have the choice to purchase a supplemental insurance policy, or Medigap. Medigap plans cover Medicare cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. and offer other benefits, but charge an additional . You cannot enroll in a Medigap plan if you have Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). .