A Medicare PPO is a plan that contains health providers who agree to see the clients of the plan at a certain rate of pay. A PPO is what is called a Preferred Provider Organization.
What exactly is a Medicare PPO?
The Medicare PPO is also a type of Medicare Advantage Plan that can be joined just like an HMO. With a PPO copays are lower as long as you see the providers within the network. Unlike HMOs, PPOs do not require you to have a primary care physician. You will also not need referrals to see a specialist, however, the plans vary and rules are different for each plan.
While under a PPO plan Medicare Parts A and B are provided to you. Not only that, there is a limit to how much you can spend out-of-pocket. Due to the fact that there is a cap in place, it will protect you from spending more than you should if medical costs are high. For example, a decade ago any Medicare Advantage plan out in the market was only allowed to set a maximum of $7,550 out-of-pocket costs.
- The choice to see doctors who are out-of-network, but it costs more
- Low premiums since you agree to the limitations and rules set by the plan
- A Part D drug plan is usually added along with the plan although, it has to be one of the drug plans tied in with the PPO plan
- Extra benefits are a possibility with PPOs however, there are limitations, possible copays, and restrictions along with the benefits
Costs with Medicare PPO Plans
- Medicare Part B will still have to be paid for separately from the PPO costs
- A monthly premium will be incurred with a PPO, granted some plans might have a $0 premium which has the possibility of changing every year
- Copays will have to be paid for medical services
- If you choose to go out-of-network be prepared to pay higher costs
- The Part D drug plan is usually attached to the plan so most times it will not cost any additional money for that part.