Medicare Advantage PPO

How Does a Medicare Advantage PPO Work?

Shopping for the right Medicare Advantage (MA) plans doesn’t have to be complicated. Most people mainly choose between PPOs (Preferred Provider Organizations) and HMOs (Health Maintenance Organizations). 

We will help clarify what Preferred Provider Organizations are and help you establish whether this is the right plan for you.

What is a Medicare PPO (Preferred Provider Organizations)?

Medicare PPOs are health insurance plans offered by private health insurance companies that contract with the Medicare program. This plan can offer Original Medicare and sometimes Part D benefits instead of getting them through Medicare itself. In a Medicare PPO, beneficiaries will usually pay lower copays if they see healthcare providers within the network.

Beneficiaries are not generally required to get referrals to see specialists or choose a primary healthcare physician. However, each PPO plan has its own rules depending on the provider, so check the plan’s benefits before signing up. No matter what, every PPO plan must offer benefits provided by Original Medicare. It must also include a maximum out-of-pocket cap on the beneficiary spending. This cap protects the beneficiary against disastrous spending when experiencing higher medical costs.

The maximum that any MA plan can set as a maximum out-of-pocket cap in 2020 is $6,700.

How a Medicare Advantage PPO Work

PPO plans feature a network of hospitals and doctors you can visit. This plan has healthcare provider networks that save on the costs of health insurance. The medical providers in the PPO network agree to take lower payments to access those in the private insurance company’s network. However, PPO networks also provide out of network care. You can use a provider who is not in your network and still be covered by your plan, but you are more likely to pay more.

With an in-network healthcare provider, you will have the lowest out of pocket costs. With a PPO plan, you can also see any specialist or doctor you want without a referral from your primary physician.  

Who is a PPO Plan Best For?

Only a beneficiary can decide if any health plan is right for them. A Medicare Advantage plan might be right for you if:

  • Your favorite doctor or hospital is already a part of the PPO network.
  • You value flexibility and freedom, and you are content with paying a little more in premiums for the flexibility.
  • You want access to more facilities and doctors.
  • You do not want to choose or work with a primary care doctor.
Learn More About Medicare PPO Plans

You want to make sure that you have access to the medications and healthcare providers that you need. An experienced Medicare expert can do this research for you. Contact Temmen Insurance to determine whether a Medicare PPO plan would be right for your needs.

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