PPO plans stand for Preferred Provider Organization. PPO plans offer more flexibility regarding healthcare providers, unlike HMO plans. Medicare Advantage PPO plans also allow you to visit any provider you like, but you have less out-pocket-costs if you visit a healthcare provider within the network.
What are PPO Plans?
Like all Medicare Advantage plans, PPO plans provide the same coverage as Original Medicare and many also provide prescription drug coverage and other healthcare needs, such as transportation and fitness membership programs. Preferred Provider Organization plans are one of the plan structures under Medicare Advantage.
PPO plans offer more flexibility than HMO plans. However, they cost more. PPO plans have a list of in-network providers but you can still get coverage if you go out of the network, though you will pay more for medical services.
You can enroll for a PPO plan in your state if you have Medicare Part A and Part B. You can register during the Annual Enrollment Period as long as you are eligible. After enrolling, you can get healthcare services from providers within the network or outside the network.
PPOs are different from HMOs in that you get coverage for visiting out-of-network providers. However, as mentioned above, if you visit providers outside the network, you will pay more than if you visit an in-network healthcare provider.
PPO plans do not require a referral to visit a specialist, unlike HMOs. However, if you visit a specialist within your plan’s network, you will pay less than if you visit a specialist outside the network. Many Medicare Advantage PPO plans also do not require you to choose a primary care physician. It is important to also confirm if the PPO plan includes prescription drug coverage.
As per the cost, PPO plans have monthly premiums in addition to the Medicare Part B premium, though there are some premium-free PPO plans.
Other plan features, such as transportation to doctor visits, fitness memberships, and dental, vision, or hearing coverage, will depend on your area and the plan provider. If you need further information about what benefits are provided with a Medicare Advantage plan in Oregon, contact us today.