A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by insurance companies.
PPO Plans have a network of doctors and hospitals. If you choose to stay within your plan’s network of doctors, hospitals, and other health care providers, you will be paying less. You can use health care providers outside of the network, but you’ll pay more.
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Do PPO plans require a primary care provider?
No, you do not need to choose a primary care doctor.
Do I have to get a referral to see a specialist?
In most cases, no.
Another important note is that if you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.
What do Medicare Advantage PPO plans cover?
PPO Plans, like all other Medicare Advantage plans, cover all Medicare Part A and B services while providing additional benefits Original Medicare does not offer.
Each plan will have an out-of-pocket maximum (another thing Medicare does not offer) and, depending on your location, may have these benefits:
- Adult day-care services
- Fitness club memberships
- Over-the-counter medications
- Prescription drug coverage
- Services and supports for those with chronic conditions
- Transportation to doctor visits
- Wellness Programs
When you can enroll
You can enroll in an Advantage when you first become eligible for Medicare and are enrolled in Parts A and B.
Your initial enrollment period is a 7-month period that begins three months before the month you turn 65 and ends three months after the month you turn 65.
If you have missed your IEP or aren’t new to Medicare, you can join or switch your Advantage plans during the annual election period from October 15 to December 7.
There is also the Medicare Advantage Open Enrollment Period from January 1 to March 31, where you can switch Part C plans or return to Original Medicare.
You may also be eligible for a special election period if you have had an unintentional loss of coverage, moved outside of your plan’s area, have gotten married, or other significant life events. You are welcome to contact us to see if you qualify for a special election period.