What is Medicare Advantage PPO?

The Medicare Advantage PPO plan is a private alternative available to anyone considering Medicare as a coverage option. With Medicare PPO, there will generally be lower copays to pay if you go to providers who are in the network. It usually isn’t required to choose a primary care provider or get referrals to see a specialist either. The Medicare Advantage PPO plan will still provide you with Medicare Part A and Part B benefits, while also opening up other coverage options. One of the included benefits with PPO is the maximum out-of-pocket caps on spending to protect against catastrophic spending. For 2020, the maximum out-of-pocket expense was set at $6,700 for the year. This provides a little more peace of mind knowing that if you were to hit that threshold, you wouldn’t have to worry about paying anything else for the remainder of the year. While a premium is still required with the plan, some insurers offer it as low as $0 for coverage.

What does Medicare Advantage PPO Cover?

When choosing Medicare Advantage as your main coverage option, you will have the choice between a PPO Plan or an HMO Plan. There is greater flexibility with Medicare PPO as you can go to out-of-network doctors and facilities at a slightly higher cost. These plans will also typically have lower premiums than a traditional Medicare supplement plan because you are following stricter guidelines laid out in the policy.

Another benefit to the Medicare PPO plan is that Medicare Part D is usually included. With Part D, costs for prescription drugs are normally lower and, in some cases, may even be free for the year if you pass certain thresholds and qualifying factors. Coverages for vision, dental, and hearing care are also a large reason why many people decide to go with one of the Medicare Advantage plans. Original Medicare doesn’t provide these options.

When comparing Medicare Advantage PPO to Medicare Advantage HMO, one of the biggest differences is where you can receive service. With Medicare PPO, you can visit doctors anywhere in the United States, even out-of-network id you pay slightly more. On the other hand, Medicare HMO limits you to visiting doctors that are only in your service area, except in the care of emergencies or urgent care.

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With more than 20 years of experience, Hitcho Insurance has been helping clients find the best coverage for themselves and their family. For more information on coverage options or to request a consultation with one of our agents, give us a call today at (610) 694-9435.

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