Medicare Advantage PPO Plans

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Generally, Medicare beneficiaries enrolled in Medicare Advantage PPO plans can receive their health care from any doctor or health care provider who accepts Medicare assignment. 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 generally 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 Advantage Plan: PPO Blue ValueRx

Medicare PPO Blue ValueRx offers a Visitor/Travel Program that includes in-network benefits and cost-sharing when you receive treatment for covered services from participating Blue Medicare Advantage PPO network providers outside of Massachusetts in the following states: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia.

Your Medicare coverage choices

There are 2 main ways to get your Medicare coverage— Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Use these steps to help you decide what coverage you want:

Medicare Advantage PPO Plans

The Medicare Part B premium. If you enrolled in Part B before 2016, you’ll pay $104.90. You’ll pay the standard premium of $121.80 in 2016 if any of the following situations applies: You enrolled in Part B for the first time in 2016; you get billed directly for your Part B premiums; you aren’t currently getting Social Security or Railroad Retirement benefits; and/or you have both Medicare and Medicaid, and Medicaid pays for your premiums. You may also pay a higher monthly premium if your adjusted modified gross income from your tax return two years ago is above a certain amount, or if you owe a late-enrollment penalty for Part B.

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