PPO Plans

Another type of Medicare Advantage plan is the Preferred Provider Organization (PPO) plan. It’s a form of Medicare Advantage plan which offers more flexibility compared to HMO plans. Preferred Provider Organization plans allow enrollees to visit out-of-network providers, though they will pay less if they stay within the network. Medicare Advantage PPOs provide more freedom as you can receive medical services from any provider you want. In this article, we’ll explore all about PPOs, including their key features.

What Are Medicare Advantage PPO Plans?

There are different types of Medicare Advantage plans, with PPO plans being one of them. Preferred Provider Organization plans are sold by private insurers contracted with Medicare. There are some other Advantage plans such as MSA, SNPs, and PFFS plans. PPO plans offer more freedom than HMO plans as they allow enrollees to choose providers that are out of network, though this would cost you more. 

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What Do PPOs Cover?

While PPOs have a list of in-network providers, you can get medical services outside of this network. Like all Medicare Advantage plans, PPO plans cover the same services that Original Medicare does, including the Part A inpatient hospital services like: 

  • Skilled nursing facility care 
  • Hospice care
  • Hospital insurance 
  • Some home healthcare services 

PPO plans cover outpatient services such as durable medical equipment, preventive screenings, ambulance rides, and other outpatient services. Many PPO plans provide prescription drug coverage and other medical services like vision, dental, hearing coverage, and fitness programs.

Eligibility

To enroll for Medicare Advantage PPO plans, you must have Original Medicare. Also, you must not have a Medicare Supplement Plan as you cannot hold both coverages simultaneously. If you’re eligible for Part C, you can register during the Annual Enrollment Period. A good agent can tell you what’s available and approved in your state. 

Keep in mind that you have to continue paying your Part B premiums to stay enrolled for Part C. Once you’ve enrolled, you can get medical services from in-network or out-of-network providers. 

Key Features

Preferred Provider Organization plans cover in-network and out-of-network services, though it pays less for out-of-network medical services — meaning you’ll pay more out of pocket if you go this route. Most PPO plans offer prescription drug coverage in addition to the services covered by Medicare Parts A and B. 

Under this plan, there’s no requirement to get a referral before visiting a specialist. You can visit both in-network and out-of-network specialists. Like other Medicare Advantage plans, PPO plans have monthly premiums, copayments, and deductibles. You must keep paying your Part B monthly premiums to stay enrolled. PPO plans also have their monthly premiums, though some plans are premium-free. 

For doctor visits, outpatient medical services, prescription drugs, and other services, you’ll pay a deductible or copayment that varies based on different factors. However, there’s an annual out-of-pocket maximum limit for PPO plans. For 2021, the limit is $8,550 for an individual and $17,100 for a family.

After you reach the out-of-pocket maximum, Medicare Advantage will cover 100% of the medical services. 

The Bottom Line

PPO plans are a good choice if you want more flexibility with the healthcare providers you visit. Also, you don’t need a referral to see a specialist, and you’re allowed to keep your doctor.

Get Help with Medicare Advantage

For more info and to get help with Medicare Advantage or other health insurance plans, contact us in Lakeland, Florida. We are Better Place Insurance Group — helping people just like you find the better plan at the better price.