What PPO Medicare Plan Should I Pick?

If you are considering enrolling in a Medicare plan, it's important to understand the different types of plans available. One type of plan that you may come across is a Medicare PPO plan.

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What is a PPO Medicare Plan?

A PPO (Preferred Provider Organization) Medicare plan is a type of Medicare Advantage plan. Like all Medicare Advantage plans, PPO plans are offered by private insurance companies that are contracted with Medicare to provide Medicare benefits to beneficiaries. PPO plans offer a network of healthcare providers that have agreed to provide services to plan members at a discounted rate. Unlike HMO (Health Maintenance Organization) plans, PPO plans allow you to see providers outside of the plan's network, but you will pay more for those services.

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PPO plans offer flexibility in choosing healthcare providers, but it is important to understand that the out-of-pocket costs may be higher for services provided by out-of-network providers. With a PPO plan, you may also have the option to see specialists without a referral, which is not always the case with HMO plans.

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Which PPO Medicare Plan should I pick?

When it comes to choosing a PPO Medicare plan, there are a few key factors to consider:

• Monthly premium: PPO plans have monthly premiums, which can vary depending on the plan you choose. Some plans have low premiums but higher out-of-pocket costs, while others may have higher premiums but lower out-of-pocket costs. Consider your budget and healthcare needs when deciding on a plan.
• Deductible and coinsurance: PPO plans may have a deductible, which is the amount you pay out-of-pocket before the plan starts paying for covered services. You should also consider the coinsurance, which is the percentage of the cost of covered services that you will be responsible for.
• Network of providers: PPO plans have a network of healthcare providers that have agreed to provide services to plan members at a discounted rate. Make sure the plan you choose includes the healthcare providers you prefer to see.
• Prescription drug coverage: Some PPO plans offer prescription drug coverage, while others do not. If you take prescription medications, make sure the plan you choose covers your medications.
• Additional benefits: PPO plans may offer additional benefits, such as dental, vision, or hearing coverage. Consider which additional benefits are important to you when choosing a plan.

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When comparing PPO Medicare plans, make sure to review the plan's Summary of Benefits and Annual Notice of Change documents. These documents will provide details on the plan's benefits, costs, and any changes that may be made to the plan for the upcoming year.

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Why choose a PPO Medicare Plan?

PPO plans offer flexibility in choosing healthcare providers, which can be important if you have a preferred provider that is not in the plan's network. PPO plans also allow you to see specialists without a referral, which can save time and make it easier to receive specialized care. Additionally, PPO plans may offer additional benefits, such as dental, vision, or hearing coverage, which can be important for maintaining overall health and wellbeing.

In summary, a PPO Medicare plan may be a good choice if you want flexibility in choosing healthcare providers and the ability to see specialists without a referral. When choosing a plan, consider the plan's monthly premium, deductible and coinsurance, network of providers, prescription drug coverage, and additional benefits. Review the plan's Summary of Benefits and Annual Notice of Change documents to make an informed decision about which plan is right for you.

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Other Resources

Learn more about PPOs in our glossary here and our article on whether an HMO vs. PPO is best for you?

We offer PPO plans and HMO plans. Call now to speak with a Keen Advisor and find a plan that fits you needs.