PPO Medicare Advantage Plan

If you have Medicare Part A and Part B, you can also obtain a Medicare Advantage plan through a preferred provider organization (PPO). When you do so, you continue to pay your monthly Medicare Part B premium to Medicare, and you also may be required to pay a monthly premium to the PPO for the additional benefits you will be receiving through the plan.

Definitions

• Health-care providers elect to participate in Medicare Advantage plans. Plan members obtain services through participating doctors, labs, hospitals, and other health-care facilities. Depending on the plan, members may have to pay an out-of-pocket monthly premium. Members commonly are assessed a copayment for doctor visits and other services rendered. Some plans allow members to choose out-of-network providers with the understanding that the member will pay a greater share of the cost. Some plans also offer vision care, screening for hearing and other benefits.

Regional or Local Plans

• Medicare PPO plans can be regional or local. Regional plans serve members in 26 separate regions of the U.S. as established by Medicare. Local plans serve their members on a county-by-county basis. Potential members should check with private insurance companies in their areas to determine which type of Medicare PPO is available for enrollment.

Plan Operations

• Members of PPO plans can obtain health-care services from network providers, usually without a referral from a primary-care doctor and without any need for advance authorization. When you utilize network plan providers, your costs for the covered services you need are usually far lower than if you had utilized non-plan providers. Some plans offer discounted services to members who voluntarily arrange for pre-authorization before visiting out-of-network providers. The plan may charge a monthly premium that is over and above the Medicare Part B premium. The plan may also charge deductibles and co-insurance, and have a variable limit on your annual out-of-pocket expenditures.

Why Choose a Medicare PPO?

• If the doctor you would normally choose as your preferred provider happens to be participating in an available PPO plan, enrollment could make sense. You would be able to continue to obtain health care from your personal physician while having some of the expenses covered. If you do not object to obtaining health-care services from a listed group of preferred providers, the PPO plan can offer you freedom and flexibility within those parameters.