PPO Plans

Like other preferred provider organization plans, Medicare Advantage PPO plans have a network of doctors, healthcare providers, and hospitals. 

However, you are not forced to see someone inside the network. You will pay less if you do, but you are allowed to use other healthcare providers and you can see a specialist without a referral.

Benefits of a Medicare Advantage PPO plan

Advantage plans offer the same benefits of Medicare Parts A and B along with some additional benefits. Your additional benefits can include: 

  • Adult day-care services
  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Prescription drug coverage
  • Over-the-counter drugs
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness programs

If you have a chronic health condition, you may also receive additional benefits specific to your situation. These could include things like meal delivery, home cleaning, education programs for your disease, visits to a nutritionist, or transportation to grocery stores.

What’s the difference between PPO and HMO?

Medicare Advantage plans come in two varieties: HMO and PPO. 

Both have a network of providers. However, PPOs allow you to see doctors outside of the network. However, it may cost you more in coinsurance. 

HMOs require you to choose a primary care provider and get referrals from them to see a specialist. PPOs do not require these things. 

HMOs have a cheaper premium but PPOs give you greater freedom. You just have to decide which of those things you would rather have.

How to enroll

If you’re eligible for Original Medicare, you’re eligible for an Advantage plan. 

You can enroll during your initial enrollment period (when you can initially enroll in Medicare). This is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65.

There is also the annual election period that spans from October 15 through December 7 every year. 

Finally, you may be eligible for a special election period if there have been significant changes in your coverage or income. 

You can find out if you are eligible by speaking with a licensed Medicare agent, but here are some instances where you would be eligible: 

  • You move outside your current plan’s area
  • Suffered unintentional loss of coverage
  • Got married
  • Had a baby

There are many more ways you can become eligible for a special election period. So, again, be sure to ask an insurance agent.

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