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Is Medicare Advantage PPO Right For You

Is Medicare Advantage PPO Right For You

Choosing the right medical insurance for you and your loved ones can be a difficult decision, and even when you qualify for Medicare things don’t necessarily get easier. If you are deciding between Original Medicare (Parts A and B) and Medicare Advantage (an all-in-one alternative to Original Medicare that bundles Parts A, B and usually D) there are a lot of factors to consider. While Medicare Advantage plans offer a number of benefits, you should make sure the plan you pick suits your specific needs and situation:

Medicare Advantage Plans: HMO vs PPO

HMO: Health Maintenance Organization plans, often referred to as HMO plans, are usually less expensive but there are often limitations. For example, you will need to select one primary health care provider, and he or she will be responsible for giving you a referral before you are allowed to visit a specialist. 

To avoid additional costs you can only use providers that your network has approved. If you choose to use a health care provider out of network, you will usually have to pay the full fee. 

Depending on your plan, your coverage may include prescription medications that fall under Medicare Plan D. This option would be best suited to those who have no underlying health conditions and don’t have a preference of health professionals.

PPO: Preferred Provider Organization plans, known as PPO plans, generally give you more options as you can either use services within the network or of your choosing. There may be extra out of pocket expenses, but you won’t be charged the full cost. 

If you want to see a specialist you usually won’t need a referral, and this can significantly reduce treatment waiting times. Your plan may include Medicare Part D, giving you coverage for prescriptions, but it is important to note that every company has different inclusions and rules. This option is best suited to those who use healthcare regularly, and people who don’t want limitations on service providers.

What is Included in a Medicare Advantage PPO Plan?

A Medicare Advantage PPO plan is usually a mix of Part A, Part B, and Part D. To apply you need to be eligible for Medicare. When deciding whether a Medicare Advantage PPO Plan is right for you, consider the services you use regularly. Think about what you might need now and in the future. 

Each plan will vary depending on your policy so it is important to read the fine print. For example, the Anthem MediBlue PPO option gives you a wide selection of in-network providers. Generally, you will find a suitable match, and this will be a low-cost option as they are billed directly to Anthem. If you want to look outside of the network, you will usually have additional costs such as copays or deductibles.

Some of the services include preventative measures such as shots and screenings, prescriptions, hearing aids, dental, and over the counter medicines. Your plan can be modified to meet your individual needs, which will give you empowerment over your own health

The Wrap Up

Our health is something we should all be mindful of, and being on the right type of plan could make a big difference to your care and expenses. 

Whether or not you choose a Medicare Advantage PPO will be a personal decision but your circumstances, preferences, and future needs may all play a role in the decision-making process. 

Before settling on a plan, take the time to do your research to understand exactly what you are getting.