PPO Plans

Preferred Provider Organization (PPO) Plans are offered within Medicare Advantage, which are plans provided by private insurance companies that contract with Medicare. 

Network Coverage

Each PPO Plan will have a network of healthcare providers and hospitals, which is predetermined. Beneficiaries are encouraged to seek treatment within that network and will pay less when they do. If a beneficiary needs an appointment with someone outside of the network, some PPO Plans will provide coverage. However, the bill may be higher.

If at any point you need emergency care and receive this care outside of your plan’s network, your plan is required to cover the out-of-pocket costs.

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Reasons to Choose a PPO Plan

One of the best things about PPO Plans is that most include Part D coverage. Drug coverage is extremely beneficial and something which most people use.  

Another great thing about PPO Plans is that most don’t require referrals. This means that appointments can be made with specialists without having to go through your primary care provider.

When comparing the differences between PPO and HMO Plans, you will find that while PPO Plans cost more, they offer more flexibility regarding who you receive your care from and where you receive it.

When to Enroll

There are several enrollment periods in which you should take note of when determining when to enroll in a PPO Plan:

• Initial Enrollment Period: The Initial Enrollment Period begins three months before an individual’s 65th birthday and ends three months after their 65th birthday. Once you are enrolled in Original Medicare, you can enroll in a Medicare PPO Advantage Plan. Or, if you become eligible for Medicare because you receive Social Security disability benefits and you are under 65, you can enroll in a Medicare Advantage Plan three months before becoming eligible and up to three months after.

• Annual Enrollment Period: The Annual Enrollment Period begins on October 15 and ends December 7. During this period, you can switch from Original Medicare to a Medicare Advantage Plan. You can also switch from one Advantage Plan to another.

• Special Enrollment Period: The Special Enrollment Period is limited to only those who qualify for it. To qualify, you must have experienced special circumstances, such as moving outside your plan’s service area and needing new coverage. Or, you delayed your Medicare enrollment because you were already covered by another health insurance plan but now need to enroll in Medicare.

If you think that a PPO Plan is right for you, we’d love to discuss it further. You can make an appointment by calling 402-740-5505.