PPO
Medicare Advantage PPO Plans
Medicare Advantage PPO Plan Benefits
The most notable feature of any PPO plan is its network of providers and facilities. If a plan member stays within the network, they’ll enjoy the maximum amount of benefits that the plan offers. There are copays and coinsurance expenses associated with these plans.
PPO plan members are not limited to the network. They can receive care from providers and facilities who are outside of the network, but the coverage will be less and the member’s out-of-pocket expenses will be higher than if they had stayed in-network.
Many of the Medicare Advantage plans have a maximum out-of-pocket limit. As it sounds, this number is the most any person on that plan will pay out-of-pocket. Once they have reached that limit, the plan pays for 100% of the costs for the remainder of the plan’s benefit period.
PPOs do not require their members to designate a primary care physician, nor do they require a referral to see a specialist. Unlike a Health Maintenance Organization (HMO) plan, a Preferred Provider Organization plan allows you to have the freedom to receive care from any health care provider that is active within or outside of your network. Nevertheless, it is always advisable to stay within your plan’s network to avoid additional costs unless you don’t mind paying a larger potential out-of-pocket amount.
Many of the Medicare Advantage PPO plans include prescription drug coverage and even offer additional benefits for dental, vision, and hearing services.
Medicare Advantage PPO Eligibility and Enrollment
Comparing PPO Plans to HMO Plans
The PPO and HMO plans in Medicare Advantage work very similarly. They each have their own network of providers and work best when their members see those providers. However, there are some benefits that PPO plans have over HMOs.
Even though PPO plans have a network, their members can go outside the network and still have benefits available. That being said, the member will have higher out-of-pocket expenses when this happens. HMO plans generally offer no benefits outside of their network, leaving a member who goes outside the network to pay their full cost for services. PPOs generally have a wider network than HMOs.
The extra benefits of a PPO plan cause these plans to come with a higher premium than the HMO plans.
At the end of the day, it comes down to what you individually find most important and valuable while looking for adequate health insurance. Make sure you take a detailed look at both plans before making a decision and consider PPO plans especially if flexibility is what you are looking for.
Comparing Medicare PPO Plans to Original Medicare
Finding the
BEST POLICY
A licensed agent can help you choose the best type of Medicare policy. We’ll ask you some questions about your lifestyle and health, and then can give you options that will fit those needs. We’ll be able to look at different plans across many carriers, so you can choose the best possible plan.
After you choose, we’ll help you through the enrollment process and will file all the necessary paperwork. Our work doesn’t end there. We’ll reach out during important enrollment periods and make sure you still have the best plan available. All of these services come at no cost to you.
Medicare Advantage PPO Eligibility and Enrollment
Any Medicare beneficiary who has already enrolled in Medicare Parts A and B is eligible to apply for a Medicare Advantage PPO plan, with one exception. Individuals who have already been diagnosed with End-Stage Renal Disease (ESRD) are not eligible for any Medicare Advantage plan. Otherwise, an individual can enroll during their Initial Enrollment Period or during the Annual Enrollment Period. Some individuals may even qualify for a Special Enrollment Period.
Medicare Advantage PPO plans are not available in all areas. Work with a licensed agent to find out which plans are available in your area.
