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PPO | Preferred Provider Organization

What is a PPO plan?

PPO (Preferred Provider Organization)

Medicare Advantage PPO Plans

Important Facts About Medicare PPO Plans

  1. PPO plans usually offer Medicare Part D prescription drug benefits. Part D is Medicare’s prescription drug benefit.
  2. If you are enrolled in a PPO MA plan, and you wish to have Medicare drug coverage you must get it from that plan. Some PPO’s offer additional benefits such as dental and vision care, but those may come at an extra cost. In order to have the lowest costs with your PPO plan you must use providers within the PPO’s network unless you find yourself in urgent care or an emergency situation.
  3. PPO’s must cover out of network services, but you may be required to pay more if you go outside the plan’s network. Some find that another benefit to a PPO is that you are able to see a specialist without a referral from your Primary Care Physician.
  4. PPO’s are limited in how much they can charge you for copays, however for some kinds of care they can and may charge more than Original Medicare. This care includes home care and care in skilled nursing facilities. Plans are required to have an annual out of pocket limit on how much you pay, but PPO’s have two different out of pocket limits, one for in-network care and one for out of network care. These limits may be high, but they can protect you from excessive costs if you need extra care or expensive treatments.
  5. If you enroll in a MA plan you will still be required to pay your monthly Part B premium of $135.50, which is the premium amount for 2019. You will also be required to pay your plan’s premium, if any, that is required by the plan. There are some MA plans with $0 premiums, but please note that even if your MA plan premium is $0 you will still be required to pay your Part B premium.
  6. You will also be responsible for any deductibles, coinsurance or copayments associated with the Medicare Advantage PPO plan you select.
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