Medicare Advantage PPO Plans

Preferred Provider Organizations (PPOs) are the flexible Medicare Advantage plans that let you visit any healthcare providers you choose. You don’t need to worry about switching providers and can even choose not to have a primary care doctor if you don’t want one. These plans give you the freedom and peace of mind knowing you can see doctors and specialists outside of your plan’s network if you need to.

Intro to PPO

Preferred Provider Organizations (PPOs) are Medicare Advantage plans that bring you a high degree of flexibility when making your healthcare decisions. You do not have to have a primary care doctor or referrals to see a specialist and are not restricted to seeing healthcare providers only within the plan’s network. Costs will vary depending on where you receive your care, but you will not need to worry about being unable to see a specialist because they are not within your network.

PPO Coverage

PPOs, as a type of Medicare Advantage plan, bring you the same coverage as Original Medicare does under Medicare Part A and Part B. That means you receive the same hospital and medical insurance coverage for inpatient hospital and skilled nursing facility care, hospice care, home health care, preventive care, and medically necessary services.

Your PPO may also offer packages for prescription drug coverage or other services not included under Original Medicare, including dental, hearing, or vision care. These plans will raise your premiums by a small amount every month (or every installment if not monthly). If your plan has prescription drug coverage, it will likely prefer you to fill your prescription medications at a specific chain of drugstore pharmacies in your region.

PPO Costs

You will need to pay premiums, a yearly deductible, copayments, and coinsurance. Copayments for doctor and emergency room visits will count toward your deductible. Once you have met your deductible, you will pay a portion of your healthcare expenses as coinsurance as a cost-sharing measure.

With a PPO, you can visit healthcare providers outside of your plan’s network but will pay more in out-of-pocket costs to do so. Seeing providers within your network is a good way to save on costs. You pay slightly higher premiums with a PPO in exchange for the flexibility of being able to receive care from any healthcare provider.

Plan Comparison

You do not need to have a primary care doctor with a PPO plan and you do not need a referral before you see a specialist. This means that if you already have a primary care doctor who is not in the plan’s network, you can continue to see them.

PPOs are one of the more expensive types of Medicare Advantage plan that you can choose. These plans are most directly comparable to HMOs and offer more flexibility.

To find out whether a PPO plan is a good health insurance choice for you, or to learn more about the available Medicare Advantage plans in your area, call us toll free at 855-GO-AVILA or click the below button to request information.