Understanding the Different Types of Medicare Advantage Plans

Not all Medicare Advantage plans are the same. In fact, choosing between an HMO, PPO, or other plan type can make a big difference in how you access care, which doctors you can see, and what you pay out of pocket.


This guide explains the most common types of Medicare Advantage (Part C) plans available in Oregon and Washington, including how they work, who they’re best suited for, and what you should keep in mind.

Which Medicare Advantage Plan Type Fits You Best?

HMO (Health Maintenance Organization)

With an HMO plan, you must use doctors and hospitals within the plan’s local network for coverage to apply. You’ll also need a referral from your primary care provider to see a specialist. These plans tend to have lower monthly costs but more limitations.

PPO (Preferred Provider Organization)

A PPO plan gives you more freedom to see any doctor, including out-of-network providers. Referrals aren’t required for specialists, but out-of-network care may cost more. PPOs are often a good fit for frequent travelers or those with specific provider preferences.

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Other Plan Types to Know

  • PFFS (Private Fee-for-Service): You can see any provider that accepts the plan's terms, but not all do. Referrals not needed. Availability varies.
  • MSA (Medical Savings Account): Combines a high-deductible plan with a savings account you can use for medical expenses. Doesn’t include drug coverage.
  • SNP (Special Needs Plans): Designed for people with certain chronic conditions or financial needs. Limited to specific groups and providers.

Not all types are available in every ZIP code. We’ll help you explore what’s offered in your area.

How to Choose the Right Plan Type for You

The best Medicare Advantage plan for you depends on:


  • Whether your preferred doctors are in-network
  • If you travel often or live part-time outside of your state or county
  • Whether you need extra benefits like dental, vision, or transportation
  • Your monthly budget and comfort with co-pays and referrals

We take all of this into account when helping you compare plans. If you're unsure where to start, our team is happy to explain your choices one-on-one.

Get the Answers Before You Enroll

  • What’s the difference between HMO and PPO Medicare Advantage plans?

    HMO plans usually require referrals and in-network doctors. PPO plans offer more flexibility, especially if you travel or see out-of-network specialists.

  • Can I go to any doctor with a PPO Medicare Advantage plan?

    You can see any provider, but you’ll pay less when staying in-network. Always check with us first so there are no billing surprises.

  • Do these plans include drug coverage?

    Most HMO and PPO plans include prescription coverage. MSA and some PFFS plans do not, so you may need to enroll in a separate Part D plan.

  • What if none of these plan types work for me?

    You might prefer Original Medicare with a Medigap supplement. Visit our Medicare Supplement page for details.

Source Attribution:
 This information was obtained from www.medicare.gov.