Medicare Advantage PPO Plans

A Medicare Preferred Provider Organization (PPO) plan is a type of Medicare Advantage plan a private insurance company offers. PPO plans include a network of doctors, hospitals, and other health care providers. If you use this network for health care, you save on Medicare costs.

Preferred Provider Organization Plans (PPO Plans)

Preferred Provider Organization Plans or PPO plans are one of the most popular managed care Medicare Advantage plans because they offer their beneficiaries more flexibility in choosing doctors and hospitals at a lower cost.

However, beneficiaries will have higher out-of-pocket costs if they go to physicians or hospitals that aren’t in PPO’s network.  All Medicare Advantage plans, including a PPO plan, are sold by private insurance companies.

All Medicare Advantage plans, including PPO,  must cover hospital and medical insurance that are normally covered under Parts A and B of Original Medicare. However, they also provide some additional benefits like dental, hearing, and vision services.

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How do PPO Plans work?

PPO Plan doesn’t require the beneficiary to stay in the provided network to provide service, but if you choose to go out-of-network be prepared for out-f-pocket costs. Unlike, an HMO plan which is another most purchased Medicare Advantage plan, PPO beneficiaries don’t need to choose a primary care physician nor referrals to see specialists. However, it is recommended to stay in provided network to avoid additional costs.

PPO Plan Coverage

As already said, every Medicare Advantage plan must offer benefits that are covered under Parts A and B. However, beneficiaries are provided with other benefits like:

  • Prescription drug coverage (over-the-counter drugs)
  • Dental, vision, and hearing coverage 
  • Fitness benefits through SilverSneakers
  • Meals at the home program- delivered to a beneficiary after an inpatient hospital stay or skilled nursing facility stay 
  • Transportation to medical appointments 
  • Adult day-care services
  • Nutrition and wellness programs

PPO Plan Costs

All plans include deductibles, copays, or coinsurance for services received. Most Medicare Advantage plans policyholders have zero dollars monthly premiums. However, as with every Medicare Advantage plan, PPOs also have an out-of-pocket limit maximum they can spend on services. After policyholders reach this limit their provider must cover all costs for the rest of the year. In 2022, the maximum out-of-pocket limit for PPOs is  7550$ for in-network services and 11300$ for out-of-network services. Because PPO plans are sold by private insurance companies costs of each plan can vary by each insurance company as well as the service area. 

Difference between HMO vs. PPO

There are a few differences between PPO and HMO Plan but in general they are not that different. However, the main differences are:

  • With HMO plan you are required to choose primary care physician who will coordinated your every medical need, and with PPO you don’t need to choose a PCP
  • HMO plan requires refferals to see specialist whilst PPO Plans don’t
  • With HMO you don’t get coverage out of network expect for emergencies and PPO plans offres you  more flexibility of choosing hospital and doctors but sometimes at higher costs

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Who Sholud Choose A PPO Plan?

Medicare Advantage PPO plan is good for Medicare enrolled who want:

  • flexibility to choose hospitals and physicians  without the restriction of a provider network or need for referrals
  • More additional benefits all in one plan
  • Have low premiums, sometimes at zero costs

We are ready to help!

If you are interested in purchasing a PPO Medicare Advantege plans our experienced agents at Turning 65 Solutions can help you to choose the best plan option that suits your needs and budget.  Call us today and get the best possible coverage for yourself!