PPO Plans

A Medicare Advantage PPO plan is a popular type of Medicare Advantage (Part C) plan. Read on to see if it’s the right choice for you.

What Is Medicare Advantage?

A Medicare Advantage plan conveniently merges all the benefits of Parts A and B.

Most plans also include prescription drug (Part D) coverage.

Preferred Provider Organization (PPO) Overview

When you join a Preferred Provider Organization plan, you select a primary care physician (PCP) for check-ups. Unlike an HMO, you don’t need a referral to see a specialist. You can also see doctors who are out of the approved network. However, you may pay a little more. 

What Is a Medicare Advantage PPO?

You can see it now — a Medicare Advantage PPO is BOTH a Medicare Advantage plan and a Preferred Provider Organization. So, it combines the benefits of an Advantage plan with the choice of a PPO.  

Who Can Enroll in a Medicare Advantage PPO?

If you’re eligible for Medicare, you can choose a Medicare Advantage PPO plan. This option appeals to people who enjoy the freedom to visit specialists without a referral and don’t mind paying extra to go to a doctor who is out of network.

What Do PPO Plans Cover?

Medicare Advantage PPO plans bundle your medical and prescription coverage into one plan where you may choose from a network of doctors and providers OR decide to see another provider out-of-network and pay more. PPO plans include similar benefits as Medicare Advantage HMO plans:

  • Preventative Services 
    • Tests
    • Shots and screenings
    • Regular check-ups at no extra cost
  • Prescription Drug Coverage
  • Vision and/or Dental care
  • Over-the-Counter Items
    • Pain relievers
    • Cold medicine
    • Other first-aid care
  • Fitness program
  • Routine hearing tests and hearing aids
The Difference Between Out-of-Network and In-Network Providers

Out-of-Network Providers

Other doctors and providers who have not agreed to work with the insurance carrier are considered out of network. When you join a Medicare Advantage PPO plan, you can decide to visit an out-of-network healthcare provider. If/when you choose to do this, your share of the cost for covered services might be higher. For example, you may pay additional deductibles, coinsurance, or copays for medical services.

In-Network Providers

A Medicare Advantage PPO plan will feature a list of providers you can pick from. These doctors and health care facilities have agreed to work with the carriers that we partner with. They’re considered in-network providers, who bill the carrier directly for your health care. When you go to a network provider, you pay a lower share of the cost. 

Typical Costs of a Medicare Advantage PPO Plan

Medicare Advantage plans can help you save money on healthcare. Since you can choose to receive care in-network or out of network, some costs, like deductibles, coinsurance, or copays, may vary within the program.

Your monthly costs may be higher with a PPO plan than with an HMO because you can make more choices about your health care. Some PPOs have $0 deductibles for medical costs, though your deductibles for out-of-network costs could be higher.

When you visit a doctor or specialist, the amount of copays or coinsurance you pay depends on whether they’re in or out of network. Again, you’ll pay the lowest amount when visiting in-network providers but have the option to pay a bit more when you wish to see an out-of-network provider.

Is a Medicare Advantage PPO Plan Right for You?

This type of plan may be right for you if:

At Hale Health Benefits, we make it easy to find and compare Medicare Advantage plans available in your Idaho county.

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