Generally, beneficiaries can receive their health care from any doctor or health care provider while enrolled in a PPO plan. These plans have network doctors and providers, but plan members are still given the flexibility to choose out-of-network doctors. Be aware that out-of-network care will cost more for the beneficiary as the PPO plan will cover less of the expenses. Some Medicare Advantage plans require beneficiaries to choose a primary care doctor to coordinate their health care, but PPO plans do not have this requirement. Additionally, referrals from a primary care doctor are not required for a beneficiary to see a specialist. Like with other aspects of care under a PPO plan, using an in-network plan specialist will usually cost less than using an out-of-network specialist.
Medicare HMO and PPO Coverage and Options
For example: George C. lives in Massachusetts and has a Medicare Advantage Plan through Fallon Community Health, one of the highest-rated health plans in the country. He has an HMO plan with drug coverage. His monthly premium cost for the plan is $208.40 (the Medicare Part B premium of $96.40 plus $112 charged by Fallon). Also, his out-of-pocket expenses include a $15 copay for each PCP visit, $20 for each specialist visit, 10% coinsurance for durable medical equipment, and an annual deductible of $310 for prescription medications.
Compare $0 Premium Medicare Advantage Plans PPO or HMO
Medicare Advantage Plans offer all of the benefits covered under Original Medicare and more. Also, most plans include Medicare Part D prescription drug coverage. To enroll in a plan, you must be eligible for Medicare Part A and B. You usually pay one monthly premium to the Medicare Advantage plan, if any, and continue to pay your Medicare Part B premium, unless otherwise paid for under Medicaid or by another third party. Medicare Advantage enrollment periods
Compare Medicare Advantage & Supplemental Plans
Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.