Medicare Advantage plans serve as a one-stop center for your health coverage needs. In many ways, these plans are similar to the Original Medicare plan but can offer you better Medicare benefits. Typically, a private company offers you a Medicare health plan based on a contract with Medicare to provide Part A and Part B benefits.
The Medicare Advantage PPO (Preferred Provider Organization) plan, in this regard, is an alternative for an individual considering opting for Medicare to obtain health coverage. Medicare PPO plan, in general, includes lower copays if your healthcare provider is in the network. There is no need to get referrals or select primary care providers to consult specialists.
Note that each PPO plan works within its own network of medical professionals and hospitals. But it doesn’t mean that beneficiary can’t enroll or use out-of-network providers for their Medicare coverage or services. They can use other networks but usually for a higher cost.
Medicare Advantage PPO Plan Coverage
Medicare Advantage plans typically come with two main coverage options that include PPO and HMO plans. The PPO plan not only offers lower premiums as compared to the original Medicare Supplement Plan but also allows you to choose out-of-network medical facilities and doctors. However, as a beneficiary, you must follow stricter guidelines and policies.
Furthermore, the Medicare advantage PPO plan covers Medicare Part D, along with Part A and B.
Obtaining coverage for Part D means you get lower costs for prescription drugs. And if you pass some qualifying factors, you may get free prescription drugs for the year. Plus, you may get better Coverages for your dental hearing with the Medicare PPO plan.
One of the key differences between Medicare advantage PPO and HMO plan is the places where you can receive services. PPO plan offers you Medicare facilities throughout the USA; even you can visit out of network doctors.
You may need to take an active role when opting for care coordination in the Medicare PPO plan. For example, if you visit healthcare providers who are not in the Medicare PPO plan’s network, you must provide information about your previous medical care and prescription drugs.
Medicare PPO Plan Cost
If you opt for the Medicare PPO plan, you will have to pay a standard premium of $135 in case of these situations. You have enrolled for the first time; you are not getting social security or any railroad retirement benefits, or have Medicaid and Medicare.
You may have to pay a higher premium monthly if your adjusted gross income from a tax return is above a specific amount or any late-enrollment penalty for your Medicare Part B. Also, you may have to pay coinsurance, deductibles, or other copayments associated with the Medicare Advantage PPO plan.
Bottom Line
Overall, Medicare advantage plans include several benefits for people looking for affordable medical coverage. However, with tons of plans and benefits, choosing the best plan is difficult. It is better to request a consultation from insurance professionals like Hitcho Insurance. For more information regarding Medicare plans, you can call us at (610) 694-9435.