Choosing a Medicare Advantage plan can come down to a single decision: an HMO vs. a PPO. While more than half of Medicare beneficiaries opt for a Medicare Advantage plan, according to KFF, finding the right one for you requires balancing your monthly budget with your healthcare network needs.
Administered by private insurance companies and approved by Medicare, both HMO and PPO options have distinct network and cost choices that you’ll need to sort through.
[READ: Worst Medicare Advantage Plans: How to Find a Good One]
HMO vs. PPO With Medicare: What’s the Difference?
Choosing a PPO plan versus an HMO plan comes down to what is available in your area and whether you want lower costs or more flexibility. Unlike original Medicare, which is standard across the country, Medicare Advantage plans vary by location and can have different benefits.
What is an HMO?
An HMO commonly offers lower-cost plan options but with less flexibility to see the providers you prefer. In general, you choose a primary care physician who then coordinates and approves specialist referrals and prior authorizations.
“HMOs tend to have a restrictive network of providers and will generally not cover nonemergent or nonurgent services provided outside of that network,” says David Lipschutz, a co-director at the Center for Medicare Advocacy in Washington, D.C.
Depending on the plan, if you do not use doctors or facilities in-network, you could be responsible for the expenses. So, check carefully if a doctor is in-network before scheduling a visit.
“Some HMOs, however, have a point-of-service option that allows a beneficiary to see providers outside of the network but for a higher cost,” adds Kelli Jo Greiner, a Medicare product manager and SHIP director with the Minnesota Board on Aging in St. Paul.
These HMO subtype plans, such as HMO-POS (point-of-service) plans, encourage using in-network providers to keep your costs low, but out-of-network services may be used at a higher out-of-pocket cost.
[READ: What to Do When Medicare Advantage Plans Deny Coverage]
What is a PPO?
PPOs tend to have higher costs than HMOs, but in exchange they give you access to a larger selection of doctors and healthcare facilities.
“PPOs tend to have a network of ‘preferred’ providers but allow enrollees to see providers outside of the network, usually with higher cost-sharing attached,” Lipschutz says.
A PPO may be a better choice for you if you already have doctors in place that you’d like to continue with but who do not participate in a plan’s network. Regardless of type, every plan is different, so always check with your health insurance company to confirm what your specific plan offers.
[READ: Medicare Special Needs Plans (SNPs): 2026 Coverage & Eligibility Guide]
How to Choose Between an HMO and a PPO
In 2026, Medicare enrollees have an average of 32 different plans to choose from, KFF reports. When considering a Medicare Advantage HMO or PPO plan, you should evaluate factors including:
— Copayments
— Extent of healthcare provider network
— Maximum out-of-pocket costs
— Monthly premium expenses
While a plan may check all of your boxes, how do you know which insurance company to choose? Each year, the Centers for Medicare & Medicaid Services (CMS) releases the Medicare Advantage star ratings, which evaluate the quality of healthcare services provided by Medicare Advantage insurance companies. This rating system enables Medicare beneficiaries to compare the quality of plans, helping them to make decisions that align with their needs.
The U.S. News Honor Roll of Best Medicare Advantage Plans uses the CMS star ratings to analyze insurance companies’ Medicare Advantage plans nationwide. U.S. News also consulted with Medicare experts to identify and weigh the most important quality measures for Medicare Advantage consumers. You can search the plans in your area by entering your state, county or ZIP code or visit individual carrier profiles to see how companies performed in specific areas such as:
— Overall rating
— Care continuity
— Screening and prevention
— Customer satisfaction
Here is a snapshot of some of the largest and top-rated companies:
Aetna Medicare Advantage
Aetna offers both HMO and PPO (as well as HMO-POS and regional PPO) Medicare Advantage plans. A regional PPO covers a wider swath of counties, particularly in rural areas.
In the 2026 U.S. News star ratings, Aetna received 3.9 out of 5 stars for its overall rating as well as its screening and prevention coverage. It also earned 4 stars for care continuity and 4.3 for customer satisfaction.
Some advantages to Aetna plans include:
— About 70% of its plans come with a $0 premium.
— Around 86% of Aetna plans with a $0 premium also offer prescription drug coverage.
— Some plans offer over-the-counter (OTC) benefits, fitness benefits, a meals-at-home program and basic dental, vision and hearing coverage.
Blue Cross Blue Shield Medicare Advantage
In 2026, Blue Cross Blue Shield (BCBS) has both HMO and PPO plans available, as well as HMO-POS plans.
BCBS Medicare Advantage plans had an overall rating of 4.2 stars out of 5 from U.S. News and 5 out of 5 stars for customer satisfaction. It also received 4.1 and 3.7 stars for screening and prevention and care continuity.
Some advantages to BCBS include:
— Out of all of its plans with medication benefits, more than half have a $0 drug deductible.
— Some plans feature an allowance for healthcare expenses and services and coverage for when you travel.
— It has the highest customer service among comparable companies offering Medicare Advantage plans.
HealthSpring Medicare Advantage
HealthSpring (formerly known as Cigna) offers HMO, HMO-POS and PPO plans. HealthSpring’s Medicare Advantage plans earned 3.5 out of 5 stars from U.S. News overall, and it also received 3.7 stars for customer satisfaction. Care continuity and screening and prevention scores were lower, 3.2 and 3.6, respectively.
Some advantages to HealthSpring plans include:
— Almost 90% of plans have a $0 premium.
— Plans can include allowances for both preventive and comprehensive dental care, hearing exams with an allowance for hearing aids and vision benefits with an allowance toward eyewear.
— Nearly all plans (93%) with a $0 premium also have prescription drug benefits.
Humana Medicare Advantage
Humana offers both HMO and PPO options, as well as HMO-POS, regional PPO and PFFS (private-fee-for-service) plans. PFFS plans allow you to see any provider who accepts Medicare and has agreed to the terms set by the insurance company.
For 2026, U.S. News awarded Humana an overall rating of 3.6 out of 5 stars. Humana also received 3.4 stars for screening and prevention, 3.2 stars for care continuity and 3.6 stars for customer satisfaction.
Some advantages to Humana plans may include:
— Some plans have an out-of-pocket maximum as low as $375.
— Many plans come with vision, hearing, dental and fitness benefits.
— It’s widely available, with plans in 46 states and Washington, D.C.
Kaiser Medicare Advantage
Kaiser Permanente offers HMO, HMO-POS and PPO plans.
For 2026, Kaiser Permanente received an overall rating of 4.2 out of 5 stars from U.S. News. Its lowest score was 3.7 for care continuity, but its highest scores reached 4.9 for both screening and prevention and customer satisfaction.
Some advantages to Kaiser Permanente plans include:
— Most plans with prescription drug benefits (96%) come with a $0 drug deductible.
— Some plans come with multiple benefits, such as discounted gym memberships and free transportation to medical appointments.
— Just under half (42%) of Kaiser Permanente plans offer a $0 monthly premium.
United Healthcare Medicare Advantage
United Healthcare offers HMO, HMO-POS, PPO, regional PPO and PFFS plan options.
In the U.S. News star ratings, United Healthcare earned 3.9 out of 5 stars. Its scores for screening and prevention (3.7 stars) and care continuity (2.7) were lower, but its satisfaction rating was 4.2 out of 5 stars.
Some advantages to United Healthcare plans include:
— About two-thirds (65%) of plans have a $0 premium in 2026.
— Of those $0 premium plans, 77% also offer prescription drug benefits.
— Like Humana, United Healthcare is available in almost every state (except Alaska and Vermont) and Washington, D.C.
More from U.S. News
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Medicare Advantage HMOs vs. PPOs: Which Is Right for You? originally appeared on usnews.com
Update 06/08/26: This story was previously published at an earlier date and has been updated with new information.
