Medicare Advantage PPO Plans

Medicare Advantage is an alternative to Original Medicare. Offered by private insurers, these plans provide the same coverage as Original Medicare and may provide additional benefits. 

The types of Medicare Advantage plans include:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNPs) 
  • HMO Point-of-Service (HMOPOS)
  • Medical Savings Account (MSA) 

Here, we’ll talk about PPO plans.

PPO Basics

A PPO is a type of plan that focuses on networks while allowing some flexibility. The preferred providers, often meaning doctors, hospitals, and other healthcare providers, make agreements with the insurance company. The agreement specifies that they provide care at a certain rate that the insurance company will reimburse them for. This deal benefits the providers because it guarantees them a patient base. The patient benefits from a PPO plan because they have a network of providers to choose from with lower costs.

A PPO plan is different from other plans because it allows the patient to choose providers from outside of their network as well. 

Pros of PPO Plans

The major pro of choosing a PPO is the flexibility. A PPO plan will allow the plan member to choose whatever provider they want. If they choose an in-network provider, their costs will be lower. If they choose an out-of-network provider, some of the costs will be covered, but they will be expected to pay more out-of-pocket costs. PPOs also do not require referrals to specialists. They also cover urgent and emergent care.

Cons of PPO Plans

The major con of a PPO plan is the cost. Because PPOs grant greater flexibility, they also cost more. Typically, the monthly premium is higher than other plans, such as HMOs.

Learn More About PPO Plans Today

Overall, PPO plans are great options for people who want flexibility and full coverage, but is it right for you?

Navigating Medicare Advantage plans is tricky enough. Understanding the ins and outs of PPO plans can add another layer of difficulty. If you’d like to learn more about whether PPO is right for you, give us a call today!

We are committed to helping you realize your health and financial goals by making you aware of all your options so that you can make the best choice for yourself and your family.

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