Medicare Advantage PPO Plans

Once you enroll for Original Medicare, you have the option of sticking with the basic coverage of Original Medicare or adding extra coverage through either a Medigap (Medicare Supplement) or Medicare Advantage (Medicare Part C) plan. There are several different types of Medicare Advantage plans, all of which are provided by private insurers.

Medicare PPO (Preferred Provider Organization) is one of the most popular Medicare Advantage plans available. Before choosing a Preferred Provider Organization plan, you must understand all of its offerings. 

What is a Medicare PPO Plan?

As the term suggests, these plans have a network of preferred providers for medical services. If enrolled in this plan, beneficiaries will have the option to receive care outside of the plan’s network if they so choose. However, you will have to pay more for using a provider out-of-network.

Since this plan is part of the Medicare Advantage plan, it must include all of the benefits provided by Original Medicare. When you sign up for the PPO plan, you are not required to choose a Primary Care Physician (PCP) or obtain a referral before seeing a specialist.

What Does Medicare Advantage PPO Cover?

PPO plans cover all services covered by Original Medicare, which include:

  • Part A:
    • Inpatient hospital care
    • Skilled nursing facility care
    • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
    • Home health care
  • Part B:
    • Clinical research studies
    • Ambulance services
    • Durable medical equipment (DME)
    • Mental Health (Outpatient)
    • Limited outpatient prescription drugs
    • Preventative services

And, of course, PPO Plans can provide additional coverage, such as:

  • Dental, vision, and hearing coverage
  • Prescription drug coverage
  • Transportation for doctor visits
  • Fitness memberships and nutrition programs
  • Wellness programs
  • Adult day-care services

Medicare Advantage PPO Enrollment Periods

Once you enrolled in Original Medicare, you can enroll in a PPO Plan during one of these enrollment periods:

  • Initial Enrollment Period (IEP): The IEP is your personalized enrollment period. It grants you seven months to enroll in Medicare. This period begins three months before the month of your 65th birthday and ends three months after you turn 65.
  • Medicare Advantage Open Enrollment Period: Throughout this period, you can switch to a different advantage plan or drop the current advantage plan you have and switch back to Original Medicare.
  • Annual Election Period (AEP): This period begins on October 15 and ends on December 7 each year. Starting January 1, you can decide what coverage you would like to have with Part C, or you can change or cancel your current coverage.
  • Special Election Period (SEP): Your qualification for the SEP will depend upon the situation you are in, which is why you should consult a licensed Medicare insurance agent, like the ones with Avila Medicare Solutions, before you make any decisions. However, in some cases, enrollment during the SEP may apply to you if you move outside your advantage plan’s service area or lose your coverage.

Who Should Get a Medicare PPO Plan?

Choosing which Medicare Part C plan is right for your needs requires careful consideration of your medical and financial situations, as well as your personal preferences. If you want to have the option to go out of the plan’s network to receive coverage, a Preferred Provider Organization Plan is definitely something to consider.

If you have more questions about Medicare Advantage PPO Plans, don’t hesitate to contact Avila Medicare Solutions in Austin, Texas to talk to an experienced Medicare expert.

Don’t wait. Give us a call now at 855-GO-AVILA, and we will answer any questions you may have.