A Medicare PPO Plan is a Medicare Advantage Plan where a Private Insurance company provides your Medicare Part A and Part B benefits and, in addition, this option includes Medicare Prescription Drug Coverage. In a Medicare PPO Plan, you can get Medical Services from any provider who accepts Medicare. The Medicare PPO has a preferred network of providers “in network” where cost sharing is lower. Other providers are “out of network”. Cost sharing is generally higher for “out of network” providers. Premiums will vary depending on the plans available in your area. Depending on the plans available in your area, some of the plans may include Dental, Vision, Hearing, Gym Memberships. Additionally, some plans may include a Maximum out of Pocket which would put a cap on your financial exposure in a calendar year.
Is this option right for me?
•If you like having your drug benefits included in with your other medical services (hospital and doctor), this could be a good choice.
•If you enjoy value added benefits, like hearing, vision, dental, gym memberships, this could be a good choice.
•If you like having care coordination services to assist you with a chronic condition, this could be a good choice.
•If you prefer a lower fixed monthly premium with higher cost sharing when you need to access benefits to a higher fixed monthly premium with lower cost sharing, this could be a good choice.
•If you value the freedom of being able to choose out of network providers in special circumstances, this could be a good choice.
•If you are satisfied with the Provider network for your basic healthcare needs, this could be a good choice.
•Financial Exposure to Part A and Part B cost sharing can be capped depending on the specifics of the plans in your area.
•Premium can be lower than a Medicare Supplement depending on the specifics of the plans in your area.
•Freedom to use “out of network” providers at a higher cost share.
•Additional Value Added benefits may be available (like Dental, Vision, Hearing and Gym benefits) depending on the specifics of the plans in your area.
•Drug benefit is integrated into plan, so you only have one card and one plan.
•Limits exposure to cost for Medicare covered Prescription drugs.
•Avoids Late Enrollment Penalty (LEP) for Medicare Part D Prescription Drug Benefits.
•Unknown Out of Pocket costs depending on your level of utilization of services in the Medicare PPO plan.
•Medicare Advantage plans are not Guaranteed Renewable like Medicare Supplement plans. In addition, the benefits can be changed on a calendar year basis.
•Higher cost sharing to use “out of network” providers.
•You do not have the ability to select a specific drug plan based on your prescription drug needs. You get the prescription drug benefit which is bundled in the plan.