What is a significant benefit of choosing a PPO over an HMO in Medicare?

Choosing a Preferred Provider Organization (PPO) over a Health Maintenance Organization (HMO) in Medicare offers a significant benefit in terms of more flexible provider access. In a PPO plan, beneficiaries have the option to see any healthcare provider, including specialists, without needing a referral from a primary care physician. This is particularly advantageous for individuals who may require specialized care or who want the freedom to choose their healthcare providers based on personal preference rather than being restricted to a network.

Additionally, PPOs typically allow beneficiaries to access both in-network and out-of-network providers, albeit at a higher cost for out-of-network services. This flexibility can be crucial for those who travel frequently or who wish to maintain relationships with certain providers who may not be in the HMO’s network.

While lower premiums, no out-of-pocket costs, and guaranteed acceptance without underwriting are characteristics that can exist in various health plans, they do not specifically highlight the primary advantage of provider access flexibility that distinguishes PPOs from HMOs.