Medicare Advantage PPO provider networks

What Is A Medicare Advantage PPO Plan?

A Medicare Advantage Preferred Provider Organization Plan, or PPO Plan, is one of the five different plan options you have when you enroll in a Medicare Part C, or Medicare Advantage Plan. A PPO Plan still provides a list of physicians and healthcare facilities that are in-network. Unlike being enrolled in an HMO plan, though, you do have the option to seek treatment by a doctor that is out-of-network for your PPO Plan. If you choose to seek covered treatment from a physician that is not in your PPO’s network, then you will most likely do so at a higher cost than if that doctor was in the network. One aspect that HMO and PPO plans have in common is that you are always covered if you must receive emergency care or urgent care, regardless of network.

You are also not required to choose a primary care physician, unlike the HMO Plan. You typically also do not require a referral to seek treatment from a specialist. Most PPO plans also offer prescription drug coverage, but it is necessary to check that the plan you are enrolling in does actually provide that coverage. There are some PPO Plans that do not offer it. 

What Is Covered By A Medicare Advantage PPO Plan?

Once you enroll in a Medicare Advantage PPO Plan, you receive all the Medicare coverage that an individual with Original Medicare would receive, plus extra benefits as well. Most Preferred Provider Organization Plans offer prescription drug coverage, and most of them also cover vision, dental, and hearing visits as well. Depending on your plan, you may also have extra benefits that include transportation to sick visits and gym membership coverage through your PPO plan. 

How Much Does A Medicare Advantage PPO Plan Cost?

While it is true that using an out-of-network provider is more costly than using one in-network, Medicare Advantage PPO Plans also have basic, stable costs that accompany the plan as well. These types of costs include deductibles, copayments, and coinsurance. Your Medicare Advantage PPO Plan has the right to charge a monthly premium for the PPO plan, as well as a separate premium for your prescription drug coverage, but this can vary as some plans may not charge premiums at all. 

You also have an out-of-pocket maximum that you must reach in order for your PPO plan to cover your services 100%. You have both an in-network and out-of-network limit maximum.

A Medicare Advantage PPO Plan is an excellent Medicare plan option if you are wanting to enroll in a Medicare Advantage Plan, but still want more freedom than an HMO Plan offers. To learn more about your Medicare Advantage options, contact Peritia Advisors today!