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Medicare
Advantage Preferred Provider Organization (PPO) Plans
Medicare Advantage
Preferred Provider Organization (PPO) plans are offered by private insurance
companies to Medicare eligible beneficiaries.They are very similar in nature to
other Medicare Advantage plans, featuring a broad network of healthcare
providers for a slightly higher fee.
What do they
cover?
PPO benefits are usually quite comprehensive, but will vary by plan. Many will
begin to offer an outpatient Prescription Drug benefit as part of the Medicare
Part D reforms. Inpatient and outpatient services, equipment and home health
services are covered to varying degrees, as are preventative services,
diagnostic testing and other services.
How much do they
cost?
Medicare Advantage PPO plans sometimes have a monthly charge in addition to the
Part B payment to Medicare, but often are $0 per month. The beneficiary pays for
services per the plan's individual schedule of co-payments or co-insurance.
What are
specific advantages?
PPOs have a very important advantage over other types of plans- a very broad
network of doctors and facilities to treat patients. There are fewer
restrictions on which physicians a patient may see.
What are
specific disadvantages?
PPOs are the latest innovation in Medicare Advantage plans, and because they are
new some healthcare providers are still getting used to them. Also, many
patients would benefit from the coordinated care and other wellness programs
available through managed care plans (not necessarily through PPOs).
For whom are
they appropriate?
In general, Medicare Advantage PPO Plans are appropriate for patients for whom:
a) Medicare Advantage is the best way to cover health care expenses (vs. Medigap
plans);
b) freedom to choose their doctors is a primary concern.
How do I select the right plan?
Selecting the right plan is a complex process that should take into
consideration a number of factors specific to the beneficiary. Put
eBenefitsByDesign.com to work finding
your plan. To compare your Medicare health plan choices, please call our
toll free number or
Complete
our Medicare Information Request Form.
If you have questions call our Toll Free Number
@ 888.995.2821
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