Medicare Advantage PPO Plans

A Medicare Advantage Plan is an alternative to Original Medicare. Offered by private insurers, Medicare Advantage Plans typically cover Parts A and B of Original Medicare with additional benefits. There are six types of Medicare Advantage Plans. A Preferred Provider Organization (PPO) is one popular option.

Overview of a PPO

A PPO is a type of plan that allows you more flexibility when choosing providers. You can receive care from any provider regardless of network. However, certain providers are preferred, meaning that they have agreed to provide you care at a certain rate to your insurance company. This saves you money. If you see someone who is not a preferred provider, you are often still covered, but you may have to pay more out-of-pocket expenses.

Medicare Advantage PPO will cover Parts A and B of Medicare, but they may also offer more benefits. The specifics of coverage also depend on each plan. Typically, a person who has a Medicare Advantage PPO may pay more for monthly premiums and copays than a person with Original Medicare.


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Pros and Cons of a PPO

The main benefit of a PPO is that you get greater flexibility when choosing a provider and receiving care. Specifically, you can see doctors and hospitals outside of your network. Additionally, you do not need a referral to see a specialist. You are always covered for emergency and urgent care. You can save money by using preferred providers, but you can also see any provider. This is useful when you are traveling within the U.S. and need care outside of your network.

The drawbacks of a PPO are the higher costs. Consumers who choose a PPO have higher monthly premiums and higher copays. They also have higher costs if they choose to see providers outside of their network. They must meet an annual deductible. The exact amount of the deductible depends on the plan.

Understanding each plan’s details is crucial to understanding whether a PPO Plan is the right option for you.