In short
- HMOs generally cover only in-network care, except emergencies, urgent care out of area and temporary out-of-area dialysis.
- PPOs cover out-of-network care, usually at a higher cost, and most do not require referrals.
- For 2027, Lancaster County's 26 standard Medicare Advantage plans include 15 PPOs, 10 HMO-POS plans and 1 HMO, per CMS plan data.
- Networks can change during the year, so check every doctor and hospital with the plan itself, every year.
HMO (and HMO-POS) vs PPO at a glance
| Feature | HMO (and HMO-POS) | PPO |
|---|---|---|
| Provider network | You generally must use the plan's network | In-network costs less, but out-of-network care is covered |
| Non-emergency care out of network | Generally not covered (you may pay the full cost); HMO-POS plans cover some services at a higher cost | Covered, usually at a higher cost, if the provider agrees to treat you and hasn't opted out of Medicare |
| Emergency and urgent care | Emergency care covered anywhere; urgent care covered out of area | Always covered |
| Primary care doctor | Required in most cases | Not required |
| Specialist referrals | Needed in most cases | Not needed in most cases |
| Yearly out-of-pocket limit | One limit for in-network Part A and B services | An in-network limit plus a higher combined limit that includes out-of-network care |
| Standard plans in Lancaster County, 2027 | 11 (10 HMO-POS, 1 HMO) | 15 |
| Drug coverage | Usually included; pick one without it and you cannot add a separate Part D plan | Usually included; same rule if you pick one without it |
| Traveling or wintering out of state | Generally emergency and urgent care only | Out-of-network care available, at higher cost |
| Prior authorization | Can apply; 7-day standard and 72-hour fast decisions since 2026 | Can apply; same 2026 decision deadlines |
The short answer
An HMO or HMO-POS plan fits people whose doctors and hospitals are all in one plan's network and who don't mind referrals. A PPO fits people who see specialists across health systems, split time out of state, or want the option of going out of network without a referral.
Every Medicare Advantage plan has a network. The difference between an HMO and a PPO is how strictly that network holds you. Pick the wrong type and you could find your specialist, or the hospital two hours away that you trust, is suddenly an out-of-pocket problem.
What is the difference between a Medicare Advantage HMO and a PPO?
An HMO generally covers care only from its network, and usually asks you to choose a primary care doctor and get referrals for specialists. A PPO covers care both in and out of network, with out-of-network care usually costing more, and most PPOs do not require referrals.
Medicare's own handbook spells out the HMO rule: you generally must use network doctors, hospitals and other providers, except for emergency care, out-of-area urgent care and temporary out-of-area dialysis. If you get non-emergency care outside the network without authorization, you may pay the full cost.
There is a middle option. An HMO Point-of-Service plan (HMO-POS) works like an HMO but covers some out-of-network services for a higher copay or coinsurance.
Both types:
- Replace Original Medicare as the way you get Part A and Part B coverage
- Usually include Part D drug coverage
- Set a yearly limit on what you pay for Part A and Part B services
- Can require prior authorization for some services
What do HMO and PPO options look like in Nebraska for 2027?
Nebraska leans heavily toward PPOs and HMO-POS plans. Plain HMOs are rare. CMS plan data for 2027 shows this mix of standard (non-special needs) Medicare Advantage plans:
| Area | Standard MA plans, 2027 | PPO | HMO-POS | HMO |
|---|---|---|---|---|
| Nebraska statewide | 30 | 19 | 10 | 1 |
| Lancaster County (Lincoln) | 26 | 15 | 10 | 1 |
| Douglas County (Omaha) | 24 | 15 | 8 | 1 |
| Hall County (Grand Island) | 21 | 13 | 8 | 0 |
Some 2027 carrier changes affect this choice directly:
- Wellcare drops its PPO "Open" plans in Nebraska and keeps its HMO-POS plans.
- Medica, which offered Medicare Advantage PPOs in 49 Nebraska counties in 2026, leaves eight eastern counties, including Lancaster, Douglas and Sarpy.
- UnitedHealthcare's AARP Medicare Advantage plans with drug coverage shrink from 52 counties to 5: Cass, Douglas, Lancaster, Sarpy and Washington.
Plan availability, premiums, networks and benefits vary by county and change every year. Our 2027 Nebraska Medicare Advantage update covers who is in and who is out.
Why does the network matter so much in Nebraska?
Because many Nebraskans get care far from home. Someone in York or Seward may see a primary care doctor locally, a cardiologist in Lincoln and a cancer specialist in Omaha. Those can be different health systems, and no plan is guaranteed to include all of them.
Never assume Bryan Health, CHI Health or Nebraska Medicine is in a plan's network. Check each doctor, clinic and hospital by name with the plan and with the provider's office. Medicare.gov's Plan Finder also lets you add your providers and see whether they are in network.
Networks can also change mid-year. Medicare's 2027 handbook says providers can join or leave a plan's network at any time, and the plan must notify you in certain cases and help you choose a new provider.
Who is an HMO or HMO-POS plan a good fit for?
An HMO-style plan fits people whose care already happens inside one network and who are comfortable with a primary care doctor coordinating it.
- Your primary care doctor, specialists and hospital are all in the plan's network.
- You rarely travel, or only need emergency coverage when you do.
- You don't mind getting a referral before seeing a specialist.
- You want the HMO-POS option for occasional out-of-network care.
Who is a PPO a good fit for?
A PPO fits people who want room to move. You trade some predictability for the right to see providers outside the network.
- Your specialists are spread across health systems or across the state line.
- You winter in Arizona, Texas or anywhere else for months at a time. See Medicare when you travel.
- You want to see a specialist without waiting on a referral.
- You understand that out-of-network care costs more and counts toward a higher combined out-of-pocket limit.
What mistakes do people make choosing between an HMO and a PPO?
The most common mistake is choosing on the plan type alone. A PPO with your doctors out of network is a worse fit than an HMO-POS with all of them in it.
Other mistakes:
- Checking one doctor, not all of them. Check every provider, including the hospital where your surgeon operates.
- Picking a plan without drug coverage by accident. If you join an HMO or PPO that does not include drugs, Medicare says you cannot add a separate Part D plan. That matters unless you have other drug coverage, such as VA benefits.
- Ignoring the out-of-network math. In a PPO, going out of network can cost far more than the in-network copay you saw first.
- Never rechecking. Read your Annual Notice of Change each fall. Your plan must send it by September 30.
- Skipping the Star Ratings. The 2027 Star Ratings post on Medicare.gov on or around October 8, 2026. Our page on Medicare Star Ratings explains how to read them.
If you join a plan and regret it, the Medicare Advantage Open Enrollment Period, January 1 to March 31, allows one change.
Where can you check plans and networks yourself?
Medicare.gov's Plan Finder shows every plan in your ZIP code, and 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week (TTY 1-877-486-2048). Nebraska SHIP (formerly SHIIP), part of the Department of Insurance, offers unbiased counseling at 1-800-234-7119. Our page on SHIP and other local help explains who does what.
If you want help checking your doctors, hospitals and medications against the plans in your county, talk to me. My help costs you nothing.
Frequently asked questions
An HMO Point-of-Service plan is an HMO that lets you get some services out of network, usually for a higher copayment or coinsurance. You still generally choose a primary care doctor and may need referrals. In Nebraska, HMO-POS plans are far more common than plain HMOs: for 2027, CMS data shows 10 HMO-POS plans and 1 HMO among Lancaster County's standard Medicare Advantage plans.
In most cases, yes. Medicare says HMO plans generally require you to choose a primary care doctor and get a referral to see a specialist, though some services, like yearly screening mammograms, do not need one. In most PPO plans, you do not need a referral, but seeing in-network specialists usually costs you less than out-of-network ones.
Often, yes, for routine care. A PPO covers out-of-network care from providers who agree to treat you and have not opted out of Medicare, usually at a higher cost than in-network care. An HMO generally covers only emergency and urgent care when you are out of its service area. If you spend months away, ask each plan how it handles care in that state.
You cannot assume that about any plan. Networks are set plan by plan, vary by county, change from year to year, and providers can join or leave a network during the year. Check every doctor, clinic and hospital you use directly with the plan and with the provider's billing office before you enroll. Medicare.gov's Plan Finder also lets you add your providers to see if they are in network.
Yes, at certain times. During the Annual Enrollment Period, October 15 to December 7, 2026, you can switch to any Medicare Advantage plan in your area for coverage starting January 1, 2027. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period, January 1 to March 31, allows one change. Special Enrollment Periods, such as moving, can allow changes at other times.
It depends on the specific plans and on how you use care. Compare the premium, the copays for the services you use most, the deductible, and the yearly out-of-pocket limit. Premiums, networks and benefits vary by county and change every year, so a plan that was the better deal in 2026 may not be in 2027. Run your doctors and medications through each plan before deciding.
Sources
- Medicare.gov: Medicare & You 2027 (CMS Product No. 10050) (opens in a new tab)
- CMS: CY 2027 Medicare Advantage and Part D landscape files (opens in a new tab)
- CMS: Medicare Open Enrollment in Nebraska, 2027 state fact sheets (opens in a new tab)
- Nebraska Department of Insurance: 2026 Medicare Advantage guide (opens in a new tab)
- CMS: Interoperability and Prior Authorization Final Rule (CMS-0057-F) (opens in a new tab)
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.
