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
What is it?
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 does it matter?
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.
Related glossary terms
Official sources
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.