4 Key Takeaways of Medicare Advantage Preferred Provider Organization (PPO) Plans

Medicare Advantage offers a great alternative for older adults who want more coverage than Original Medicare can provide. The two most common Medicare Advantage (MA) plans are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). While HMO plans are sometimes cheaper, they are far more restrictive than PPO. As a result, MA PPO plans are some of the most popular options on the market. Let’s take a closer look at the 4 key takeaways of Preferred Provider Organization (PPO) plans.

PPO Gives You Medicare Part A and Part B

A lot of people misunderstand what Medicare Advantage plans actually provide. Both HMO and PPO plans give you all the same benefits as Medicare Part A and Part B (Original Medicare). Though each part offers specific benefits, Part A generally helps with inpatient hospital care, while Part B pays for outpatient care.

Most PPO Plans Don’t Require Specialist Referrals

When you need to see a specialist for a medical issue, the last thing you want to worry about is jumping through extra hoops. Fortunately, in most situations, PPO plans (and Original Medicare plans) do not require you to get a referral to see a specialist. Instead, you can see the specialist directly as you see fit. However, it’s important to note that you may pay less for your care if you choose an in-network specialist.

PPOs Do Not Require You to Seek In-Network Care

With an HMO plan, you are limited to a network of doctors, clinics, and other medical facilities. While you may pay a little less for your premiums, you will likely not be covered for care outside of your network. Alternatively, PPO plans give you the freedom to choose in-network or out-of-network care — though you may have to pay more for care outside of your network.

You Don’t Need to Choose a Primary Care Provider

One of the primary benefits of a PPO plan is that you’re not required to choose a primary care provider. This means that you can see any doctor within your network and still get all the same benefits that you would with a primary care physician. With an HMO plan, you are required to choose a primary care physician, putting even greater limitations on your Medicare coverage.

The Bottom Line

As you can see, Preferred Provider Organization (PPO) plans are the best option if you want greater flexibility with your Medicare coverage. If you’re worried about needing coverage outside of your network, you should definitely consider a PPO, as an HMO or similar plan could put too many restrictions on where you can receive care. In any case, Medicare Advantage plans — both HMO and PPO — generally provide more coverage than Original Medicare.

If you’d like to learn more about Medicare Advantage PPO plans or your Medicare coverage options, feel free to fill out this form or give us a call anytime. Time for 65’s partnered licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.