Medicare Preferred Provider Organization (PPO) plans are a type of Medicare Advantage program. These plans include a network of doctors, hospitals, and other healthcare providers to protect what you pay out of pocket.
You’re eligible if you’re enrolled in Original Medicare (Parts A and B) AND you live in the coverage area of the PPO plan you want to join.
When you join a PPO plan, it will essentially replace your Original Medicare—providing the same benefits as well as additional coverage. You’ll get an enrollment packet that includes your plan’s summary of benefits.
What You Should Know
There are local PPOs (more common) and regional PPOs (less common).
Local PPOs have a smaller network size, like one or more counties. Regional PPOs have a larger network area, such as statewide.
What Do PPO Plans Cover?
- Inpatient hospital coverage
- Outpatient medical coverage
- Prescription drug coverage
- Some plans offer dental and vision benefits
- Some plans include a fitness benefit
Medicare Advantage PPO Costs
With a PPO plan, you’ll usually have to continue paying the Part B premium. You’ll also typically be responsible for a monthly plan premium, copays and coinsurance, Part D copays, and higher costs if you go out of network.
However, PPOs have a maximum out of pocket (MOOP), which is the most you can pay on your own for care during the year. Once your spending hits the MOOP amount, your PPO plan covers all your costs for services.
How and When to Join a PPO Plan
Joining a Medicare Advantage PPO plan is different from Original Medicare. You can purchase a plan through the insurance company directly or use a broker like the ones at InvoBH. There are certain times of the year that you can do this, most notably being the Annual Enrollment Period—from October 15 to December 7 each year.
Networks are based on location, and the exact costs and coverage will vary. A good way to find a quality PPO plan is to compare options in your area with a licensed professional.
How PPO Plans Stack Up Against the Competition
It’s important to research your options before joining a Medicare Advantage plan.
PFFS and SNPs are more exclusive, with specific eligibility requirements. For most individuals, the two most accessible options are HMO and PPO plans.
HMOs are less expensive than PPOs, but PPOs give you more freedom and flexibility with managing your healthcare services.
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Compare Your Options with Us.
At InvoBH, we specialize in Medicare Advantage plans. When it’s time to compare your options in The Show-Me State, reach out to us—we’ll tell you what benefits are available in your area and help you choose the most suitable coverage for your health needs and budget!