Medicare Advantage PPO Plans
Preferred Provider Organizations (PPOs) are flexible Medicare Advantage plans that allow you to visit any health care provider you choose. You don't need to worry about changing providers, and you can even choose not to have a primary care physician if you don't want to. These plans give you the freedom and peace of mind knowing that you can see doctors and specialists outside of your plan's network if you need to.
To learn more about PPOs and whether they are right for you, talk to a PPO agent. Avila Medicare Solutions.
Introduction to PPO
Preferred Provider Organizations (PPOs) are Medicare Advantage plans that give you a high degree of flexibility in making your health care decisions. You are not required to have a primary care physician or referrals to see a specialist, and you are not restricted to seeing health care providers only within the plan's network. Costs will vary depending on where you receive your care, but you don't have to worry about not being able to see a specialist because he or she is not in your network.
PPO Coverage
PPOs, as a type of Medicare Advantage Plan, give you the same coverage as Original Medicare with Medicare Part A and Part B. That means you get the same coverage as Original Medicare for inpatient and skilled nursing facility care, hospice care, home health care, preventive care, and medically necessary services. That means you receive the same medical and hospital 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 prescription drug coverage packages or other services not included in Original Medicare, including dental, hearing or vision care. These plans will increase your premiums by a small amount each month (or each payment if it's not monthly). If your plan has prescription drug coverage, you will probably prefer that you get your prescriptions filled at a specific pharmacy chain in your area.
PPO Costs
You will have to pay premiums, an annual 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 health care expenses as coinsurance as a measure of cost-sharing.
With a PPO, you can visit health care providers outside your plan's network, but you will pay more in out-of-pocket costs to do so. Seeing providers within your network is a good way to save costs. You pay slightly higher premiums with a PPO in exchange for the flexibility of being able to receive care from any health care provider.
Plan comparison
You do not need to have a primary care physician with a PPO plan and you do not need a referral before seeing a specialist. This means that if you already have a primary care physician who is not in the plan's network, you can continue to see him or her.
PPOs are one of the most expensive types of Medicare Advantage plans you can choose. These plans are more directly comparable to HMOs and offer more flexibility.
To find out if a PPO plan is a good health insurance option for you, or for more information about Medicare Advantage plans available in your area, call us toll free at 855-GO-AVILA or click the button below to request information.
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