Medicare Advantage PPO Plans--Key Tips to Understanding the Medicare PPO
Medicare Advantage PPO plans are one kind of Medicare Advantage Plan, or Medicare health plan. To understand what this means, it is necessary to understand what the term "Advantage Plan" means in Medicare lingo and also the definition of a PPO plan. Don't worry, neither are these are complicated.
A Medicare Advantage plan is what is also known as Part C of Medicare. The plans are another way for Medicare beneficiaries to receive Medicare hospital and doctor benefits. That is to say, the plans are an optional way to receive your Part A and Part B benefits. The Advantage plans, such as the Advantage PPO plans, must offer all of the same benefits that Original Medicare offers. The plans may offer additional benefits that Medicare doesn't offer, such as dental, hearing, and eyeglasses, but at the very minimum, they must make available the same level of coverage that you would receive in the Original Medicare program. Many Medicare health plan also offer the option of bundling Part D, which refers to the Medicare prescription drug coverage, together with Part A and B into one package.
There is often confusion as to the difference between Original Medicare and the Medicare Advantage Plans. Original Medicare is the Medicare program managed by the Federal government, available anywhere in the United States and its territories, and the program that allows Medicare beneficiaries to go to any doctor, specialist, hospital, or supplier who is enrolled in the Medicare program. Original Medicare is the program you are initially enrolled into when you turn 65. It is also the Medicare program associated with the red, white, and blue Medicare health insurance card you receive when you first enroll.
The Medicare Advantage PPO is a privately managed preferred provider organization (PPO) and is offered by private insurance companies authorized by Medicare to provide this sort of coverage. A PPO has a network of doctors, hospitals, and other health care providers on contract with the PPO insurance company whom you can see. The network of providers are the "preferred providers." The Advantage PPO also gives you the flexibility to to go other doctors, specialists, and hospitals not in the PPO network, but that costs you more. In other words, the level of coverage, or the amount the insurance company pays, is greater when you go to providers in the network and more expensive when you seek medical services out of network. Like all Advantage Plans, the Medicare PPO is the sole payer on your claims, and Original Mediare does not pay unless you disenroll and return to Original Medicare coverage. When considering whether or not to join a Medicare PPO, it is essential that you check with your doctors and oth er
health care providers to be sure that they are either in the plan's network or are otherwise willing to submit claims to the insurance company and accept payment.
One question many people have is whether or not the Medicare PPO is a supplemental insurance. The answer to that is "no." In Medicare, a supplemental insurance is always the secondary payer and therefore always pays after Medicare. In an Advantage Plan, whether it is a PPO, health maintenance organization (HMO), or private fee for service plan (PFFS), the plan is always the only payer on your claims, and Original Medicare never pays for the duration of your enrollment in the Advantage Plan.
Is there really any "advantage" to the Medicare Advantage PPO plans? Tough question. There is simply no one-size-fits-all health insurance coverage that is right for all Medicare beneficiaries. In order to determine whether or not such a plan is right for you, You must carefully compare benefits, cost sharing (your out of pocket costs), and access to doctors, hospitals, suppliers, and other health care providers necessary for your particular needs.
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