Medicare Advantage PPO plans work very much in the same fashion as HMO in that there is a network of providers and doctors and a maximum yearly out of pocket. There are a few differences in PPO plans in that generally the out of pocket is higher as well as co pays are slightly elevated over their HMO counterparts. Also, PPO offerings may have a deductible involved but the advantage is the addition of more doctors and hospitals in the plans network.
These plans may or may not have a plan premium whereas several more of the HMO types hove none other than your normal Part B premium to Medicare. Also there will be both an in network out of pocket and an out of network out of pocket if you choose a provider not in network. The out of network providers must agree to accept the terms and conditions of the plan in order to get covered treatment; generally look for providers that accept Medicare on assignment.
MAPD PPO plans also include your drug prescription coverage better known as Part D coverage, easing the hassle of searching not only for an advantage plans but also a Part D plan.
PPO plans work great in some counties where the HMO network of providers may be “thin” in the sense the network is not strong on doctors and hospitals. They also fit nicely for the Medicare beneficiary that just doesn’t like the structure and potential restrictions of an HMO.
Value added benefits like the Silversneaker gym program, dental, vision and hearing coverage are generally included in these plans just like the HMO offerings so you do pick up lots of nice extras over and above you normal medical care. Also,PPP plans are offered by private insurance companies that have contracts with Medicare and you will still have Parts A & B coverage however you will receive your care through the private insurance company.
Since most PPO Advantage plans have little to no plan premium other than your normal Part B premium they make an excellent choice over traditional Medigap or supplement plans that have not only a monthly premium but you will also have your Part D drug premium.
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