Medicare Advantage PPO Plans
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What is a Medicare Advantage PPO plan?
A Medicare Advantage PPO plan*, or a Preferred Provider Organization plan, is available through a private insurance company contracted with Medicare to provide and coordinate benefits for beneficiaries. Each PPO plan has its own network of doctors and hospitals. Individuals enrolled in a Medicare Advantage PPO plan are allowed to use out-of-network providers for Medicare covered services, but usually for a higher cost.
Covered benefits under a Medicare Advantage PPO plan
|Medicare Advantage Preferred Provider Organization (PPO) plan|
|Are prescription drugs covered?||In most cases, yes, but contact the plan to be sure. If you want prescription drug coverage, you must enroll into a Medicare Advantage PPO plan that offers prescription drug coverage.|
|Do I need to choose a primary care doctor?||No.|
|Do I have to get a referral to see a specialist?||Not in most cases, but you may want to check with your plan to be certain.|
Medicare Advantage PPO plan costs
If you enroll into a Medicare Advantage PPO Plan, costs associated with the plan include:
- The Medicare Part B premium. You’ll pay the standard premium of $134 in 2017 if any of the following situations applies: You enrolled in Part B for the first time in 2017; you get billed directly for your Part B premiums; you aren’t currently getting Social Security or Railroad Retirement benefits; and/or you have both Medicare and Medicaid, and Medicaid pays for your premiums. You may also pay a higher monthly premium if your adjusted modified gross income from your tax return two years ago is above a certain amount, or if you owe a late-enrollment penalty for Part B. However, if you enrolled in Part B before 2017 and receive Social Security benefits, your premium might be lower ($109 per month on average).
- The monthly plan premium, if any, required by your Medicare Advantage plan. Some Medicare Advantage plans have a $0 premium; however, please note that even if your Medicare Advantage plan doesn’t have a premium, you must continue to pay your Medicare Part B premium.
- Deductibles, coinsurance, or copayments associated with the selected Medicare Advantage PPO plan.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.