When shopping for Medicare Advantage in Florida, you will encounter two primary plan types: HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). Understanding the difference is essential to choosing a plan that works for your healthcare needs and lifestyle.

Medicare Advantage HMO Plans

HMO plans require you to use a specific network of doctors and hospitals. You typically need a primary care physician (PCP) who coordinates your care and provides referrals to specialists. Going outside the network — except for emergencies — means paying full cost out of pocket.

HMOs generally have lower premiums and lower out-of-pocket maximums than PPOs. They work well for seniors who have established relationships with in-network providers and do not need to see out-of-network specialists.

Medicare Advantage PPO Plans

PPO plans give you more flexibility. You can see any Medicare-accepting provider, but you pay less when you use in-network providers. You do not need referrals to see specialists. Out-of-network care is covered, though at higher cost-sharing rates.

PPOs typically have higher premiums than HMOs but provide the flexibility that many Florida seniors — particularly those who travel or split time between states — need. If you have a specialist you see regularly who is not in an HMO network, a PPO may be your only Medicare Advantage option.

HMO-POS: A Hybrid Option

Some Florida Medicare Advantage plans offer an HMO Point-of-Service (HMO-POS) structure. Like an HMO, you have a primary network, but you can go out-of-network for certain services at higher cost-sharing. This hybrid can be a good middle ground for seniors who mostly use in-network providers but want occasional flexibility.

Which Is Right for You?

Choose an HMO if: your doctors are in the network, you want the lowest possible premiums, you are comfortable with referrals, and you live in Florida year-round.

Choose a PPO if: you have out-of-network specialists you need to see, you travel frequently or split time between states, you want flexibility without referrals, or you are willing to pay slightly higher premiums for freedom.

The 2026 Context

With Humana and UHC exiting Florida counties, many seniors are being forced to change plans regardless of preference. If your current HMO is being discontinued, this is an opportunity to evaluate whether a PPO or Medigap better fits your needs going forward.

Call (435) 612-1009 for a free comparison of HMO and PPO options in your Florida zip code.