If you’re exploring Medicare Advantage plans in 2025, you’ve likely encountered different plan types—HMO and EPO being two of the most common. While both options are designed to lower out-of-pocket costs and offer comprehensive coverage, there are important differences in network flexibility, referrals, and out-of-network care.
In this guide, we break down HMO vs EPO for Medicare Advantage, so you can choose the right plan based on your health needs, lifestyle, and budget.
What Is Medicare Advantage?
Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans typically include:
- Medicare Part A (hospital) and Part B (medical)
- Most include Part D (prescription drug coverage)
- Additional benefits like dental, vision, hearing, fitness programs, and OTC allowances
The structure of a Medicare Advantage plan—HMO, EPO, or PPO—affects how you access care and what providers you can use.
Overview: HMO vs EPO in Medicare Advantage
| Feature | HMO (Health Maintenance Organization) | EPO (Exclusive Provider Organization) |
| Primary Care Physician (PCP) | Required | Not required |
| Specialist Referrals | Required | Not required |
| In-Network Care Required | Yes (except emergencies) | Yes (except emergencies) |
| Out-of-Network Coverage | No (except emergencies/urgent care) | No |
| Provider Flexibility | Limited – must use network PCPs | More flexibility within a broader network |
| Typical Cost | Lower premiums and copays | Mid-range premiums; predictable copays |
| Availability | Widely available nationwide | Limited availability depending on the carrier |
What Is an HMO Medicare Advantage Plan?
An HMO Medicare Advantage plan requires you to:
- Choose a Primary Care Physician (PCP)
- Get referrals to see specialists
- Stay within the plan’s network for all non-emergency care
Key Advantages:
- Lower monthly premiums
- Coordinated care through one primary doctor
- Lower out-of-pocket costs if you stay in-network
Drawbacks:
- No coverage for out-of-network providers
- Limited provider flexibility
- Referrals required for most specialist visits
Best for: Seniors who want lower costs and don’t mind using a local network with referrals.
What Is an EPO Medicare Advantage Plan?
An EPO Medicare Advantage plan allows you to:
- Access in-network care without a referral
- See specialists directly without PCP approval
- Use a pre-selected network, but no out-of-network benefits
Key Advantages:
- No need to choose a PCP
- No referrals required for specialists
- Simpler access to care within a managed network
Drawbacks:
- No out-of-network coverage (except emergencies)
- Slightly higher costs than HMO plans in some markets
- Limited availability compared to HMOs
Best for: People who want some flexibility without referrals, but are comfortable staying in-network.
Cost Comparison: HMO vs EPO Medicare Advantage (2025)
| Cost Element | HMO Plan | EPO Plan |
| Monthly Premium | $0 – $50 (many $0 options) | $0 – $70 (varies by region) |
| Primary Care Visit | $0 – $25 | $0 – $30 |
| Specialist Visit | $25 – $50 (with referral) | $30 – $60 (no referral) |
| Out-of-Network Cost | Not covered | Not covered |
| Prescription Drugs | Included in most plans | Included in most plans |
| Dental/Vision/Hearing | Included | Included |
Verdict: HMO plans are typically more affordable, while EPO plans offer referral-free access at slightly higher costs.
Availability by Provider
Not all insurers offer both HMO and EPO Medicare Advantage plans in every state. Here are a few providers that offer one or both options:
| Insurance Company | HMO Plans | EPO Plans | Notes |
| UnitedHealthcare (AARP) | Yes | Limited | Mostly HMOs with a few EPOs in select states |
| Blue Cross Blue Shield | Yes | Yes | EPO plans in some regional BCBS affiliates |
| Cigna | Yes | Some | EPOs available in metro areas |
| Humana | Yes | No | Primarily offers HMO and PPO options |
| Molina Healthcare | Yes | Yes | EPO plans available in select markets |
Tip: Always check your ZIP code on Medicare.gov or the insurer’s website for the most up-to-date availability.
Key Considerations Before Choosing
Choose an HMO Medicare Advantage Plan if you:
- Want lower premiums and predictable copays
- Don’t mind getting referrals to see specialists
- Are okay sticking with a local network of doctors
Choose an EPO Medicare Advantage Plan if you:
- Prefer not to deal with referrals
- Want a balance between structure and independence
- Live in a region where EPO plans are offered with a broad provider network
Final Thoughts
Both HMO and EPO Medicare Advantage plans offer affordable alternatives to Original Medicare, each with its own strengths.
- HMO plans are ideal if you’re looking for low-cost, coordinated care
- EPO plans offer more freedom to see specialists without referrals, as long as you stay in-network
Before enrolling:
- Compare plans at Medicare.gov
- Confirm that your doctors and hospitals are in-network
- Check out Star Ratings and extra benefits like dental, vision, or fitness programs