Medicare Advantage PPO Plans
What are Medicare Advantage PPO Plans?
Medicare Advantage Preferred Provider plans are provided by private insurance companies that are connected to a network of healthcare providers and facilities in a specific area in the United States.
Whenever you get access to healthcare services within this network, you will pay a fraction of the price and if you do not, you will pay the full amount.
How Medicare Advantage PPO Plans differ from HMO Plans
While the two plans may look similar at first glance, there are quite a few differences that set PPO Plans apart from HMO plans and they are as follows
- Doctor’s visits
With PPO Plans, you can visit healthcare providers outside your carrier’s network. While seeing doctors out of your Medicare Insurance provider’s network may cost you more with PPO plans, HMO plans do not allow you to do so.
- Choosing a primary care physician
With PPO plans, you do not have to choose a primary care physician, but with HMO plans, however, it is mandatory to do so.
- Referrals
Unlike HMO Medicare Advantage plans, you do not need referrals from your primary care physician to visit specialists in PPO plans.
- Premiums
PPO plans come with more flexibility in comparison to HMO plans, and as a result, they come with higher premiums.
How Medicare Advantage PPO Plans can benefit you
Depending on your Medicare Advantage insurance providers and area, PPO plans give you access to healthcare benefits that do not come with Original Medicare at little to no extra premium costs. These benefits may include:
- Adult day-care
- Chronic condition healthcare services and support
- Prescription and over-the-counter drugs
- Dental, vision, and hearing
- Doctor’s appointment transport costs
- Fitness and wellness programs
Moreover, you do not have to choose a primary care physician or have a referral to visit healthcare specialists!
It is however important to note that each Medicare Advantage plan is different and you should always look at what benefits your plan of choice gives before enrolling. At Your Life Agency, our licensed Medicare insurance agents are always ready to help you find the best Medicare Advantage plan in your area to suit your needs.
Medicare Advantage PPO Enrolment periods
As per US federal government regulations, you can only enroll in Medicare Part C plans at specific periods during the year as follows:
- Initial Coverage Election Period
This seven-month period starts three months before and ends three months after your 65th birthday month.
People below 65 living with disability become eligible for Medicare advantage plans 25 months from the date they become Social Security beneficiaries. Their enrolment period opens three months before and closes three months after their 25th month of receiving these benefits.
- Annual Election Period (AEP)
This enrolment window is open from the 15th of October to the 7th of December annually and your Medicare coverage begins on January 1st the following year. Changes to your Medicare coverage plans can only be done before your Medicare coverage begins after you have enrolled.
- Medicare Advantage Open Enrolment Period
This window gives you the freedom to change to a different Medicare Advantage plan or opt for Original Medicare Coverage.
- Special Election Period
Special Election Enrolment periods are made on an exceptional basis and they differ depending on each individual’s situation and they allow you to make changes to your Medicare Advantage plans.
These instances may arise when you move out of your Medicare Part C coverage area, when you need additional healthcare services or when you move into a nursing home.
Comparing Medicare Advantage Premiums
At Your Life Agency, our licensed Medicare insurance agent can help you compare the cost of Medicare Advantage plans and find the one with the benefits that best suit your needs while giving you value for money.