Glossary
HMO vs PPO (Network)
Two common Medicare Advantage plan structures — HMOs require in-network care, PPOs allow out-of-network at higher cost.
Also known as: HMO, PPO, provider network
Quick answer
HMO (Health Maintenance Organization) plans require you to use in-network providers and usually need referrals to see specialists. PPO (Preferred Provider Organization) plans let you see out-of-network providers at higher cost-share and typically don't require referrals.
Why it matters
If you travel frequently, snowbird, or have specialists in multiple states, a PPO is usually a safer fit than an HMO. TFL works with both — but only as secondary to the MA plan's network rules.
When you'll encounter it
When shopping MA plans during AEP.
Impact on Medicare
Defines how Medicare benefits flow through the MA plan.
Impact on TRICARE For Life
TFL wraps both — but on out-of-network HMO care, neither MA nor TFL may pay much.
Common misconceptions
- "TFL will cover anything the MA plan doesn't." — Only if it's still a TRICARE-authorized service from an eligible provider.
Continue learning
— suggested by the knowledge graph- AEP & OEP (Election Periods)AEP (Oct 15 – Dec 7) is when you can join, switch, or drop MA plans. OEP (Jan 1 – Mar 31) lets you change MA plans once.
- Annual Election Period (AEP)October 15 – December 7 each year — the main window to join, switch, or drop a Medicare Advantage or Part D plan, with coverage starting January 1.
- Coverage DecisionA formal decision by a Medicare Advantage or Part D plan about whether — and how — it will cover a service, item, or prescription.
- Dental Benefits (Medicare Advantage)Dental coverage included with most Medicare Advantage plans — exams, cleanings, fillings, and sometimes crowns and dentures.
- Emergency Coverage (Medicare Advantage)Emergency room care is covered by MA plans nationwide — in or out of network — at the plan's emergency copay.
- Expedited AppealA fast-track appeal for situations where standard timeframes could seriously jeopardize the beneficiary's health or ability to regain function.
- Fitness Benefits (Medicare Advantage)A free gym membership program (SilverSneakers, Renew Active, Silver&Fit, etc.) included with most Medicare Advantage plans.
- Five-Star Special Enrollment PeriodA once-per-year SEP that lets you switch into a CMS-rated 5-star Medicare Advantage or Part D plan available in your area.
- How exactly does TFL pay when I have Medicare Advantage?MA pays primary as if it were Medicare. TFL pays secondary as a wraparound — covering MA copays for in-network services. Out-of-network MA care leaves gaps TFL may not fully cover.
- When can I enroll in or switch Medicare Advantage plans?Annual Enrollment Period (Oct 15 – Dec 7) for next-year coverage. MA Open Enrollment Period (Jan 1 – Mar 31) for one change. Special Enrollment Periods for qualifying life events.
- Will I lose TRICARE For Life if I join Medicare Advantage?No. As long as you keep Medicare Part B, TFL stays. Inside an MA plan, MA becomes primary and TFL becomes a secondary wraparound for in-network MA cost-shares.
- Do Medicare Advantage plans require prior authorization?More often than Original Medicare. MA plans commonly require PA for imaging, specialty drugs, certain procedures, SNF stays, and home health. Original Medicare + TFL has very few PA requirements.
- How do I decide between Medicare Advantage and just Original Medicare + TFL?Stay with Original Medicare + TFL if you want maximum provider choice and travel often. Consider MA if you want a Part B giveback, dental/vision/hearing add-ons, and your doctors are in network.
Related glossary terms
Related Official Resources
Continue learning straight from the source. Every link below goes to an official government or DoD resource.
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.