Chaperone Health Insurance Plus
Medicare Advantage HMO vs. PPO in Broward County
Reviewed October 2026 · Covers the 2027 plan year
Two Medicare Advantage plans can look alike on paper and still work very differently once you need care. Much of that difference comes down to the plan type: whether it’s an HMO, an HMO-POS, or a PPO. That one choice affects whether you need referrals, whether you can see doctors outside the network, and what happens when you travel. I’m Roxroy Ashley, an independent licensed agent with HealthMarkets, based in Fort Lauderdale, and I help people in Broward County compare Medicare Advantage HMO plans and Medicare Advantage PPO plans against their own doctors, hospitals, and prescriptions.
The 2027 Annual Enrollment Period runs October 15 to December 7, 2026, and several South Florida PPOs are ending or changing for 2027. Below, I explain how each plan type works, what to check in Broward, and how to decide which fits the way you get care. When you’d like to talk it through, book a free plan review and I’ll get back to you personally within 24 to 48 hours.
I’LL EVEN CALL YOUR DOCTOR
Get a Free Quote From a Broker Who Compares Medicare Advantage PPO Plans and HMO Plans
The plan type matters most where it meets your real life, so before I recommend any plan, I check:
- Your doctors and hospitals against each plan’s network, and whether your specialists need a referral
- Your prescriptions and pharmacy against each drug list
- Your full-year cost, including a PPO’s combined out-of-network limit
If anything is unclear, I call your doctor’s office to confirm it. Your quote is free, with no obligation to enroll. Get your free quote and I’ll do the research for you.
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Why Choose Me to Compare HMO and PPO Plans
When you’re choosing a Medicare Advantage plan type, here’s what to look for in an agent, and what you can expect from me.
Your Doctors, Hospitals, and Prescriptions Checked First: I know South Florida’s health systems, including Memorial Healthcare System, HCA Florida, and Baptist Health, which helps me spot network gaps early. Before I recommend any plan, I check your doctors, hospitals, and every prescription against its network and drug list, including your pharmacy. If something is unclear, I’ll call your doctor’s office myself.
Every Question Answered, at Your Pace: Referrals, networks, and two different out-of-pocket limits are a lot to sort out, and most people spend less than an hour choosing a plan. I take as long as you need, explain each piece in plain language, and answer every question until it makes sense. There’s no pressure and no obligation to enroll.
The Plan That Costs Less for You: I add up the premium, copays, deductibles, drug costs, and out-of-pocket limits for each plan, including a PPO’s combined limit, based on the care you actually use.
My Help Costs You Nothing Extra: Insurers pay my commission, and plan premiums are generally the same whether you enroll through me or directly, so you get personal guidance and ongoing support at no additional charge.
Both Paths, Side by Side: I lay out the HMO, HMO-POS, and PPO options that fit your situation, and Original Medicare with a Medigap plan when that fits too, and explain what you’d gain and give up with each.
I Handle the Paperwork: If you choose a plan, I complete the application with you, confirm your enrollment window, and follow it through to approval, so the process is as simple as a conversation.
Licensed and Verified: I’m licensed in 33 states, I complete AHIP’s annual Medicare certification, and I’m certified for the 2027 plan year. You can verify my license (Florida License #W323530, NPN #17946070) anytime through your state’s insurance department.
I Stay Your Agent After You Enroll: Work with me directly, in person, by phone, on Zoom, or at your home in Broward, Miami-Dade, or Palm Beach, and I reply within 24 to 48 hours. If a referral gets stuck or a claim doesn’t look right, I’ll help you sort it out, and I review your coverage every Annual Enrollment Period.
You can read all 25 reasons we should work together on my Why Choose Me page.
How a Medicare Advantage HMO Works
For how Medicare Advantage plans work overall, including Special Needs Plans and enrollment periods, start with my Medicare Advantage plans page.
A Medicare Advantage HMO (health maintenance organization) is built around a network of doctors, hospitals, and other providers. In most HMOs, you choose a primary care doctor who coordinates your care, and you usually need a referral from that doctor before you see a specialist. Some services, such as a yearly screening mammogram, don’t need a referral.
In-network care is the rule. With an HMO, you generally need to get your care from providers in the plan’s network. If you see a provider outside the network for routine care, you may have to pay the full cost. Medicare sets three important exceptions: emergency care, urgent care when you’re outside the plan’s service area, and dialysis when you’re temporarily out of the area are covered even out of network.
Prior authorization may apply. Many HMOs require the plan’s approval before certain services, such as some imaging, surgeries, or durable medical equipment. That’s also true of many PPOs, so it’s worth checking for any plan you’re considering.
HMO-POS plans add some flexibility. An HMO-POS (point-of-service) plan works like an HMO, with a network and a primary care doctor, but it covers some services out of network, usually at a higher copayment or coinsurance. Which services count, and what they cost, depends on the plan. In South Florida, some 2027 HMO-POS plans are offered in Broward and Palm Beach, so I include them in the comparison when they fit.
Medicare Advantage HMO plans can work well for people whose doctors and preferred hospital are all in the same network, who are comfortable having a primary care doctor coordinate referrals, and who get nearly all of their care close to home.
How a Medicare Advantage PPO Works
A Medicare Advantage PPO (preferred provider organization) also has a network, but it gives you more room to go outside it. You’ll pay less when you use in-network providers, and you can still see out-of-network providers for covered services, usually at a higher cost. Most PPOs don’t require you to choose a primary care doctor, and you usually don’t need a referral to see a specialist.
Out of network still has rules. An out-of-network provider has to be one who can be paid by Medicare, so doctors who have opted out of Medicare generally aren’t covered except in an emergency. Medicare also recommends contacting your plan before out-of-network care, to confirm the service is covered and medically necessary. Emergency and urgent care are always covered.
Two out-of-pocket limits. Every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services. PPOs usually have two: an in-network limit, and a higher combined limit that counts both in-network and out-of-network spending. Once you reach the in-network limit, you pay nothing more for covered in-network services for the rest of the year, and the combined limit works the same way for all covered services, in network or out. I check both limits for every PPO we consider.
Medicare Advantage PPO plans can make sense if one of your doctors is outside the networks you’re considering, if you see several specialists and want to skip referrals, or if you spend part of the year away from Broward. The trade-off is that seeing providers out of network usually costs more, so the flexibility is most valuable when you’ll actually use it.
Medicare HMO vs. PPO Costs: What Drives Your Yearly Total
When people compare a Medicare HMO vs. PPO, they often look only at the premium. Your true yearly cost has several parts, and they can add up differently for each plan type.
Premium: many PPOs charge a monthly plan premium, and some HMOs do too. With any Medicare Advantage plan, you also keep paying your Part B premium.
Copays and coinsurance: what you pay for each doctor visit, specialist visit, hospital stay, and test. In a PPO, out-of-network cost sharing is usually higher than in-network cost sharing for the same service.
Deductibles: some plans have a deductible for medical services, a separate deductible for out-of-network care, or a drug deductible.
Out-of-pocket limit: each plan sets its own limit, which can’t be higher than Medicare allows. Comparing limits helps you see your worst-case year, not only your typical year.
Prescription drugs: most HMOs and PPOs include Part D drug coverage, but some don’t. If you join a Medicare Advantage plan without drug coverage, you generally can’t add a separate Part D plan. Plans without drug coverage are mainly a fit for people with other creditable drug coverage, such as from the VA, so I confirm how you’ll get your prescriptions covered.
Because each of these pieces depends on your own doctors and prescriptions, I build a full-year cost estimate for every plan we compare. All quotes are estimates and are not final until you’re enrolled.
Snowbirds, Travel, and Care Outside Broward
If you split the year between Broward and another state, or travel often to see family, the plan type deserves extra attention.
Emergencies are covered anywhere in the U.S. Every Medicare Advantage plan covers emergency care and out-of-area urgent care, whether it’s an HMO or a PPO. Coverage outside the United States varies by plan.
Routine care away from home is the bigger difference. With most HMOs, a routine checkup or a specialist visit in another state isn’t covered unless it’s an emergency or urgent need. A PPO may cover out-of-network care in another state at its out-of-network cost sharing, and some carriers have networks or travel benefits that reach beyond Florida. Those details are plan-specific, so I check them for the places you actually spend time.
Watch the six-month rule. Medicare Advantage plans are tied to a service area. Under Medicare’s rules, if you’re away from your plan’s service area for more than six months in a row, the plan generally has to disenroll you. Some plans offer a visitor or traveler program that lets you stay enrolled for up to 12 months while away, but only some plans have one.
Where is your permanent home? You join a Medicare Advantage plan based on where you live. If you’re thinking about making Florida your permanent home, or moving away from it, the plans available to you can change with your address. Some frequent travelers look at Original Medicare with a Medicare Supplement (Medigap) plan instead. That path has its own trade-offs, including a separate Part D plan and, in many cases, health questions if you apply outside your Medigap open enrollment period. My Medicare Advantage vs. Medicare Supplement guide walks through both paths.
Checking Doctors and Hospitals in Broward County
Broward has several large health systems, and Medicare Advantage networks don’t always include all of them. Before comparing any plan, I check whether it includes the hospitals and doctors you rely on, such as those in Memorial Healthcare System (with hospitals in Hollywood, Pembroke Pines, and Miramar), Broward Health, HCA Florida Healthcare (including HCA Florida Woodmont Hospital in Tamarac), Cleveland Clinic Florida in Weston, and Baptist Health, which has a medical center in Plantation and outpatient locations across the county.
Networks can change. A plan can add or drop providers during the year, and hospital contracts are sometimes renegotiated. If a provider leaves your plan’s network, the plan is expected to make a good-faith effort to notify you at least 30 days ahead. Checking matters most with an HMO, since an HMO generally won’t pay for routine out-of-network care.
PPO choices are shifting for 2027. According to a South Florida Sun-Sentinel review of CMS’s 2027 plan data, insurers in Florida are moving some members from PPOs into HMOs, and Broward has 17 PPOs plus five PPO Special Needs Plans for 2027. If your current PPO is ending, merging, or changing to an HMO, your plan’s Annual Notice of Change or non-renewal letter will say so. My guides to 2027 Medicare Advantage changes in South Florida and ANOC and non-renewal notices explain what to do next.
Which carriers I work with offer each type. Based on the 2027 South Florida plan listings I reviewed, the carriers I work with offer these Medicare Advantage plan types, depending on county: Aetna, Humana, Florida Blue, and UnitedHealthcare offer both HMO and PPO plans; Wellcare offers HMO-POS plans; CarePlus offers HMO and HMO-POS plans; and Devoted Health offers HMO plans. Availability varies by county and address, so I confirm what’s offered where you live.
What to Check Before Choosing a Plan Type
List your doctors and hospitals first. Write down every doctor you see, including specialists, and the hospital you’d want to use. If all of them are in one HMO’s network, an HMO may cover everything you need. If one isn’t in any HMO you’re considering, a PPO may be worth a look.
Ask how often you see specialists. If you see several specialists, think about whether getting referrals through a primary care doctor feels like helpful coordination or an extra step.
Count your months away. If you spend part of the year outside Broward, check how each plan handles routine care away from home, and whether it has a visitor or traveler program.
Compare the full-year cost, including the worst case. Look at the premium, copays, deductibles, and the out-of-pocket limit, including a PPO’s combined limit if you expect to go out of network.
Read your 2027 Annual Notice of Change. If you’re already in a plan, check whether its network, plan type, or costs change on January 1, 2027.
Check whether you may qualify for a Special Needs Plan. If you have both Medicare and Medicaid, live with certain chronic conditions, or live in a facility such as a nursing home, a Special Needs Plan may be an option. SNPs come in HMO and PPO forms too, and all of them include drug coverage. My Extra Help and Special Situations page has more on dual eligibility.
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Frequently Asked Questions About Medicare Advantage HMO and PPO Plans
What Is a Medicare Advantage PPO Plan?
A Medicare Advantage PPO plan is a type of Medicare Advantage plan offered by a private insurance company approved by Medicare. It has a network of preferred providers, and you pay less when you use them, but it also covers care from out-of-network providers, usually at a higher cost. Most PPOs don’t require a primary care doctor or referrals. Like every Medicare Advantage plan, it’s a different way to get your Part A and Part B benefits, not a supplement to Original Medicare.
Is a Medicare HMO or PPO Better?
Neither is better for everyone. Medicare Advantage HMO plans may fit if your doctors are all in the network and you get most of your care in Broward. Medicare Advantage PPO plans may fit if you want to keep an out-of-network doctor, skip referrals, or get routine care while traveling, and you’re comfortable paying more when you go out of network. The best way to decide is to check your own doctors, prescriptions, and full-year costs against each option.
Do I Need a Referral in a Medicare Advantage HMO?
In most HMOs, yes, for specialist visits, though some services don’t need one. Rules vary by plan, so I check each plan’s referral rules before you choose. Many HMO and PPO plans also require prior authorization for certain services.
Can I Switch From an HMO to a PPO, or From a PPO to an HMO?
Yes, during the Annual Enrollment Period, October 15 to December 7, 2026, with your new plan starting January 1, 2027. Special Enrollment Periods may also apply after certain events, like a move or your plan leaving your area. Before switching, it’s worth looking at what you’d give up as well as what you’d gain: an HMO usually means a tighter network and referrals, and a PPO may mean higher costs when you go out of network. I’ll lay out both sides.
What Happens if My Doctor Leaves My Plan’s Network?
Providers can leave a network during the year. Your plan should make a good-faith effort to tell you at least 30 days ahead, and you’ll usually need to choose a new in-network provider for covered care. In a PPO, you may still be able to see that doctor at out-of-network cost sharing. If you think a network change puts your care at risk, you can call your plan or 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week.
Do You Offer Every Medicare Advantage Plan in My Area?
No. We do not offer every plan available in your area. Currently we represent 8 organizations which offer 65 products in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week, to get information on all of your options. In Florida, you can also get free Medicare counseling through the state’s SHIP program, called SHINE.
For more Medicare guides, visit my Medicare Knowledge Center.
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Pick a time for a free 15-minute call by phone or video. Bring a list of your doctors, your preferred hospital, and your prescriptions, and I’ll check how each HMO and PPO option covers them. My help never costs you anything extra.
Call or text: (954) 410-3710
Email: contact@chaperonehealthinsuranceplus.com
Office: 6360 NW 5th Way Ste 101, Fort Lauderdale, FL 33309
Meet by: phone, video, at my office, or at home in Broward, Miami-Dade and Palm Beach.
- How It Works
How we'll work together
Five steps, no pressure, and I stay with you after you enroll.
1
We talk about you
By phone, Zoom or face to face. Your health, your budget, your doctors.
2
I check the details
Doctors, hospitals, prescriptions and pharmacy, checked against each plan.
3
We compare real costs
A full-year estimate for each option, explained in plain language.
4
You decide, I enroll you
No pressure. If you choose a plan, I handle the application with you.
5
We review every year
Plans and networks change. I check yours each year and help with claims in between.