Preferred Provider Organization (PPO) plans are a type of Medicare Advantage (Part C) plan, and provide a network of healthcare providers at a reduced cost from Original Medicare. It is one of 4 Advantage plan options (the others being SNP, HMO, and PFFS plans).
You must be enrolled in both Medicare Part A and Part B before you are eligible for a PPO plan. This, however, is the only eligibility requirement. PPO plans are flexible, inexpensive, and a great option for many Medicare beneficiaries.
PPO plans cover the out-of-pocket costs of Original Medicare. This typically includes the copayment/coinsurance fees involved in regular maintenance and healthcare, such as doctor’s visits.
Cost coverage is reliant on a network of healthcare providers. Any care received within this network will be at little to no cost to you—anything outside of the network will, then, cost more.
A network is a collection of doctors, offices, etc. that have been established by your insurance provider. PPO plans offer a wide range of coverage. Specific offerings, however, will vary depending on the insurance company and your location.
Because of this vast network, PPO plans are very flexible. They offer:
With other Advantage plans, you may be required to visit one primary care physician before seeking any other treatment or specialist. With a PPO plan, you can visit anyone you like, with costs covered within the aforementioned network.
In terms of additional benefits, like almost every Advantage plan, most PPO plans will provide prescription drug coverage. They also offer limited dental, vision, and hearing services.
However, keep in mind that these benefits are very limited. Typically, plans only include regular checkups in these areas, not specific treatment or equipment.
More than likely, then, you will be choosing between an HMO or a PPO plan. HMOs are less expensive than PPOs. They do, however, offer a significantly smaller and much less flexible network.
HMO plans require a primary care physician, specialist referral, and offer an overall smaller network range of coverage than PPOs. If you are more concerned with finances, an HMO may be a better choice for you. On the other hand, if you need flexibility, a PPO will likely serve you better.
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