PPO Plans
What Is a Medicare Advantage PPO Plan?
Preferred provider organization (PPO) plans are a type of Medicare Advantage (Part C) plan — an alternative to Original Medicare — that include a network of doctors, labs, hospitals, and other healthcare providers.
If you see a provider in the PPO plan’s network, you pay costs at the in-network rate, which may include copays, coinsurance, and a monthly premium.
You can visit a provider outside of the network if you wish, but your out-of-pocket costs will be higher. Keep reading to learn more about Medicare Advantage PPOs and whether this type of plan is right for you.
Maximum Out of Pocket
PPO plans have a maximum out of pocket (MOOP) — the most you can pay on your own for medical care during the year. Once your spending reaches the MOOP amount, the plan covers all your costs for services.
PPO plans are an appealing option because you usually don’t need a referral from your primary care physician (PCP) to see a specialist. And, many PPOs include prescription drug coverage, and some offer dental and vision benefits.
Your Costs Will Vary
PPO plans are sold by individual insurance carriers, which means the costs (premiums) , out-of-pocket maximums, and kinds of plans available will vary — depending on the carrier, plan, and service area.
Get the right coverage at the right price.
Who Is Eligible for a Medicare Advantage PPO Plan?
To join any Advantage plan, you have to enroll in Original Medicare (Parts A and B). The first time you can sign up is during your Initial Enrollment Period (IEP), which happens during the months surrounding your 65th birthday. After that, there’s an Annual Election Period (AEP) from October 15 to December 7 each year. Lastly, certain events might qualify you for a Special Enrollment Period (SEP).
AEP is the period when most people change their coverage. Keep in mind that PPO plans can change at any time.
Who May Benefit from a PPO?
- People looking for a portion of out-of-pocket coverage
- Those who want the lower rate of an Advantage plan
- Beneficiaries under 65 on disability
- People with a limited income
Some Special Needs Plans (SNP) are available to those with certain health issues.
Medicare Advantage PPO vs. HMO
Medicare Advantage PPOs and HMOs have networks of medical providers. But there are big differences between them.
HMO plans typically work with a network of local providers, and you may pay the FULL cost of care if you go to a doctor outside of the network.
Meanwhile, PPOs might have broader networks. With a PPO, you can see providers that aren’t in the network, although it will cost you more.
Generally, the monthly premium for a PPO plan will be higher than an HMO plan. However, a PPO plan gives you more freedom and flexibility in managing your healthcare.
How to Enroll in a Medicare Advantage PPO Plan
With healthcare costs on the rise, it’s important to find the right Medicare coverage for your needs. Oak Haven Insurance can help by shopping the top insurance carriers in Texas and providing FREE plan quotes, so you can determine the best option for you. Call today or fill out our contact form to get started!
