Considering Medicare PPO – Read This Before You Enroll

Medicare PPO plans have some attractive features but are they worth considering?

If you are enrolled in Medicare you have some choices to make. You can stay with original Medicare and enroll in Part D, purchase a Medigap policy and enroll in Part D or join a Medicare Advantage plan that more than likely will include Part D coverage.

If you choose to enroll in a Medicare Advantage plan you may have Medicare PPO (Preferred Provider Organization) plans available.

This article is designed to give you an overview of what a Medicare PPO plan is, the pros and cons of PPO Medicare Advantage plans and give you a profile of who would benefit from this type of plan.

What is a Medicare PPO plan?

A Medicare PPO is a Medicare Advantage plan also known as Medicare Part C. Medicare Advantage plans are offered by private insurance companies approved by Medicare. The plan will provide all of your Part A and Part B coverage as well as emergency and urgent care coverage.

A Medicare Advantage PPO plan will include a list of doctors, specialists, hospitals and other providers. This list is your Preferred Provider Network.

You are allowed to receive services out-of-network but you will generally pay more. Cost sharing can take the form of co-payments, coinsurance or deductibles.

Most PPO Medicare plans include Part D drug coverage. Plans often include additional benefits not normally found in original Medicare like; dental, vision, hearing, gym memberships and other health and wellness programs.

 Medicare Advantage PPOs come in two varieties:

• Regional Medicare PPO that may be single or multi-State
• Local Medicare PPO that is offered in a single County

 Preferred Provider Organization (PPO) pros and cons

These pros and cons are relative to an individual’s needs and circumstances. What may be a major draw back for one person may be less so for another.

Pros

• Medicare Advantage plans in general often have a lower premium than a Medigap policy and in some case offer a $0 premium.
• A PPO network can give the best of both worlds: lower in-network cost and the freedom to go out-of-network.
• Peace of mind knowing what your services will cost.
• Saving money by choosing a plan with Part D coverage.
• The extra benefits can be of value.

Cons

• If the network is limited you may find yourself paying more out-of-network more frequently.
• Overall costs for services are a little higher for a PPO than for a Medicare HMO plan.
• If you choose a Medicare Advantage PPO plan without Part D coverage you cannot enroll in a stand-alone Part D plan.

Who will benefit by this type of plan?

If you weighed your options between a Medicare Advantage plan versus a Medigap policy and decided on the Advantage plan it’s now time to choose between the different types of Advantage plans.

Plans that include a Preferred Provider Network are popular choices because they offer a greater amount of flexibility than a Health Maintenance Organization (HMO).

Below are some characteristics of people who may choose a Medicare Advantage PPO plan:

• Someone who likes the flexibility of a Medigap policy but cannot afford the premiums.
• Someone who likes the idea of Medicare Advantage but doesn’t want to be locked- into a HMO.
• Someone who wants an all inclusive plan that includes Part D as well as some extra benefits.

Your ability to enroll in a Medicare PPO  is subject to having plans available in your service area. Once you get the hang of navigating the medicare.gov website you should be able to locate all available plans.

If you are considering enrolling in a Medicare Advantage plan a PPO may be a good choice. Compare plans online or visit the Medicare website to find plans that may suit your needs.