There are two main kinds of Medicare Advantage plans: Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs).
PPOs are offered by private insurance companies. This type of plan covers all the benefits of Original Medicare (Part A and Part B) with a network of preferred as well as out-of-network doctors.
PPOs have higher premiums and out-of-pocket costs than HMOs. They include extras not offered with Original Medicare or Medicare Supplement, as well as extras like dental, vision, hearing aids, gym memberships, and more.
Like HMOs, PPOs also limit how much you pay every year, but your out-of-pocket maximum will generally be higher with a PPO plan.
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Some things to keep in mind with a Medicare Advantage PPO
- Monthly premiums and out-of-pockets are higher than Medicare Advantage HMOs. (Most HMO plans have a $0 monthly premium. However, you will be required to pay the standard Part B premium since Part B comes packaged in the plan.)
- PPOs have higher deductibles than HMOs. You must pay these before the plan’s coverage starts.
- Monthly premiums do not increase based on age.
- You can choose to get care at in-network or out-of-network doctors.
Note: Out-of-network providers will cost more.
- In some areas, the difference between a PPO preferred network and HMO network is not a lot.
- Most PPOs don’t require a designated primary care physician, so you don’t have anyone to oversee all of your healthcare needs. You will be responsible for managing and coordinating your care, and for identifying your specialists.
- Healthcare providers are not held responsible for delivering care based on national standards and evidence-based medicine.
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