What is medicare advantage ppo?

A PPO is a type of. Medicare Advantage Plan (Part C) Medicare Advantage Plan (Part C) A type of Medicare-approved health plan from a private company that you can choose to cover most of your Part A and Part B benefits instead of Original Medicare. It usually also includes drug coverage (Part D).

• Limited service providers. If you choose one of the more popular Medicare Advantage plan types, such as an HMO plan, you may be limited in the providers you can see.
• Complex plan offerings.
• Additional costs for coverage.
• State-specific coverage.

Medicare Preferred Provider Organizations (PPOs) are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, PPOs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some PPOs offer additional benefits, such as vision and hearing care.

Eligibility and costs basics

You must have both Parts A and B to join, and generally you will continue paying your Medicare Part B premium. Your PPO may also charge an additional premium, on top of the Part B premium. If you want Part D coverage, you will receive it through your PPO. Plans may charge a higher premium if you also have drug coverage.

Note: If you join a Medicare Advantage Plan and you want Part D coverage, you must receive coverage from your plan. You cannot enroll in stand-alone Part D coverage unless you join a Medical Savings Account (MSA) or Private Fee-for-Service (PFFS) plan that does not offer prescription drug coverage.

Benefits access basics

Once you have joined a PPO, you should receive a benefit card from your plan. You will use your PPO benefit card instead of your Medicare card when you go to the doctor or hospital.

After enrolling in a PPO you can see any provider, but you generally pay more when seeing out-of-network providers. PPO plans typically offer fixed copayments when you use the plan’s network.

There are two types of Medicare PPO plan:

Medicare Advantage plans provide Medicare coverage through private health insurance companies approved to participate in the Medicare program. These plans can be HMOs, PPOs, Regional PPOs or Private Fee-for-Service plans.

Medicare Advantage plans provide all Part A and B services while generally including some additional services, such as wellness programs, hearing aids and vision services. These plans also tend to have lower cost sharing overall and a maximum that you would have to pay for out-of-pocket costs each calendar year–a feature not available through Original Medicare.