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Medicare Advantage plans are health care plans that have been approved by Medicare. Such plans are offered in the market via private insurance carriers. Those who wish to enroll in a Medicare Advantage plan must first be eligible for Medicare, and be enrolled in Medicare Parts A and B.
There are several different types of Medicare Advantage plans. Some of the most common of these operate in a similar fashion to managed care HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations).
Preferred Provider Organizations, or PPOs, consist of networks of providers who charge on a fee-for-service basis. However, these providers are actually paid by the PPO through a negotiated, discounted fee schedule.
Medicare Advantage PPO plans provide access to a network of health care providers and hospitals that coordinate their enrollees’ care. This helps enrollees to essentially get more care than they otherwise would receive in Original Medicare (Medicare Part A and Part B).
For example, the Medicare PPO plan may include additional benefits such as dental, vision, and hearing coverage. Medicare Advantage plans must also offer the same benefits that are provided via Original Medicare as well. Many of the PPO plans may also include prescription drug benefits, however, this is not automatically included in all PPO plans.
While not as stringent as an HMO (Health Maintenance Organization), those who are enrolled in a PPO are also encouraged to utilize providers who are listed in a network. If such network providers and facilities are used, the PPO participants will receive a discounted rate on their services.
Should providers and facilities from out-of-network be used, then the enrollee will be required to pay more for their care. PPO enrollees are not, however, typically required to obtain a referral from a primary care physician before seeing a specialist.
Before deciding on a Medicare PPO plan, there are several factors to keep in mind. First, you will want to ensure that your health care providers are listed within the PPO network, as well as the hospitals and pharmacies that you are likely to use. This way, you will be able to keep your costs down when using such services.
When shopping for a Medicare Advantage PPO plan, it is also important to be aware of which plans are available in your particular geographic area. In addition, you will also need to compare premium price, as cost can differ a great deal between plans and insurance carriers.
We work with many highly rated Medicare Advantage carriers in the marketplace, and can help you to obtain the quotes for multiple Medicare Advantage plans that you need to make good solid policy and premium comparisons. Doing so online can make the process easy and convenient.
Simply use the form on this page in order to get started. If you have any additional questions or concerns regarding how Medicare Advantage PPO plans work, please feel free to contact us directly at 800-376-0824 and we will be happy to assist you.
When it comes to obtaining health care coverage for those age 65 and over, there are various options available. In addition to Original Medicare (Medicare Parts A and B), there are numerous HMO plans, available through the Medicare Advantage program, that could provide additional coverage such as dental, vision, and hearing – along with reduced… Continue Reading