Medicare PPO Plans
A Medicare PPO plan is the most convenient way to customize and expand your Medicare benefits.
Medicare Advantage PPO plans allow you to expand your Medicare benefits to include vision, dental, and prescription drug coverage. They also save you money on out-of-pocket by eliminating Medicare copays, coinsurance, and deductibles.
Below we take a closer look at how these flexible policies can help you protect your health and your bank account.
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Understanding Medicare PPO Plans
A Medicare Preferred Provider Organization (PPO) is a local area network of doctors and care providers that coordinate and administer all the benefits and services included within your plan.
Two main benefits of PPO policies:
See the doctor of your choice – PPO policies allow you to see doctors both in or out of your local network. However, these plans incentivize you to see a ‘preferred provider’ by offering lower rates for in-network doctors.
No referral process – A Medicare PPO policy allows you to freely schedule any health care service covered within your plan without needing a doctor’s referral.
Difference Between Medicare PPO, HMO, & FFS Plans
There are three types of Medicare Advantage plans. PPO’s, HMO’s, & FFS. Each type has its pros and cons. Here’s a quick overview.
HMO Plans – Medicare HMO (health maintenance organizations) plans require that you establish a primary care physician to be the coordinator of all your health care needs. To schedule or receive any health services outside your primary doctor, you’ll need to obtain a referral first.
The referral process helps reduce waste and needless services; therefore, HMO plans are usually the lowest cost Medicare Advantage option. However, this process can be very frustrating for individuals in poor health, for they will require a new referral each time they wish to schedule a health care service outside their primary care physician.
Medicare HMO plans also limit you to seeing to in-network doctors only. Therefore, if you need to see a specialist out-of-network or are traveling out-of-state, you will not be covered by your plan. HMO plans have the least flexibility but offer the lowest premium rates.
FFS Plans – Medicare FFS (fee for service) insurance policies do not provide traditional coverage; instead, they enable people to pay a fixed price for the services that they need. FFS plans are the least popular type of Medicare Advantage plans. However, healthy individuals who do not expect to use their Medicare benefits much in the upcoming year may find this option attractive. Individuals with less than ideal health will find HMO & PPO plans better suited for their needs.
PPO Plans provide the flexibility of seeing in or out-of-network doctors as long as they accept Medicare patients. PPO plans also do not require a referral to schedule and receive health care services, making them the most convenient and flexible way to customize your Medicare benefits.
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Cost of Medicare Advantage PPO Plans
How much do Medicare PPO plans cost? The answer to this question depends on your health, age, state of residence, zip code, gender, and the insurance carrier you choose to purchase from.
Medicare PPO plans typically cost more than HMO’s or FFS plans. However, one should not pick a health insurance plan solely on cost. As discussed above, each policy type has its pros and cons. It’s up to you as the consumer to assess which type of policy is best for your health and your bank account.
Our Medicare experts are here to help you navigate which policy type is best for your life situation. We then help you shop and compare Medicare Advantage plans from all the providers in your state so you can find your lowest cost option.
How Medicare Helps Pay for Your Medicare Advantage
Did you know that Medicare helps pay for your Medicare Advantage PPO plan? It’s true. Each month Medicare sends a check to the issuing carrier of your plan to cover your Original Medicare benefits bundled inside. Therefore, when you purchase a Medicare PPO plan, you only pay for the added services beyond your Original Medicare.
Finding Your Best Option
Shopping for a Medicare Advantage can be a tedious process. As discussed above, there are different types of policies and many carriers to shop and compare. The good news is our independent agency is here to make things simple.
Our specialized agency has helped thousands of seniors customize their Medicare benefits, and we’d love to help you too!
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We’re here to answer all your questions and help you locate your best policy offers.
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