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Medicare Advantage PPO Plans
What is a Medicare Advantage PPO Plan?
A Medicare Advantage PPO plan, or a Preferred Provider Organization is offered by a private insurance company. PPO Plans have network doctors and hospitals. Individuals enrolled in this type of plan can use out-of-network providers for covered services, but usually for a higher cost.
PPO Plan types
There are two types of Medicare Advantage PPOs, a Regional PPOs, which is set by Medicare and serves one of 26 regions. A Local PPOs serve the counties the PPO Plan chooses to include in its service area.
Covered Benefits under a Medicare Advantage PPO Plan
| Preferred Provider Organization (PPO) Plan | |
| Are prescription drugs covered? | In most cases, yes. Ask the plan. If you want drug coverage, you must join a PPO Plan that offers prescription drug coverage. |
| Do I need to choose a primary care doctor? | No. |
| Do I have to get a referral to see a specialist? | No. |
Medicare Advantage PPO Plan Costs
If you enroll in a PPO Plan, costs associated with the plan include the following:
- The Medicare Part B premium (for 2011, the premium is $115.40 for most individuals. Those enrolled in Medicare Part B after January 1, 2011 or whose income exceeds certain limits will pay a higher Part B premium).
- Part A and Part B , prescription drug coverage , and extra benefits above the Medicare Part B premium
- Deductibles, coinsurance, or copays associated with the selected PPO Plan
- Maximum amounts, or caps, for out-of-pocket costs in a Regional PPO (for both in- and out-of-network care). For Local PPO Plan, the plan may or may not have a cap.
