2020 Medicare Advantage PPO
Preferred Provider Organization Made Easy
Medicare Advantage PPOs
With Medicare Advantage PPOs, you will generally only see healthcare providers within the plan’s network, but, unlike HMOs, you can choose doctors and services outside the PPO network for a fee, and you do not need referrals to see a specialist.
Ashford Insurance offers 2020 Texas Medicare Advantage PPO (Preferred Provider Organization) Plan, Part C of Medicare, from UnitedHealthcare® Medicare Solutions. PPOs offer choice in providers and flexibility to see providers outside the plan’s network.
2020 Texas Medicare Advantage PPO plans, often called Medicare Part C, combine Medicare Parts A & B (Original Medicare) into one plan. However, instead of receiving the benefits of Parts A & B through Original Medicare, Medicare Advantage plans are offered through private insurers, like UnitedHealthcare®, that are approved by Medicare.
You can get your Texas 2020 Medicare benefits through Original Medicare, or you can choose a Medicare Advantage PPO Plan. With Original Medicare, the government pays for your Medicare benefits when you get them. Medicare Advantage PPO Plans, the Part C of Medicare are offered by private companies that have been approved by Medicare. Medicare pays these companies to administer your Medicare benefits.
If you join a Texas Medicare Advantage PPO Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. They are completely different than a Medicare Supplement Insurance (Medigap) policy.
Regional Preferred Provider Organization (RPPO) plans: With a RPPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You generally pay more if you use doctors, hospitals, and providers outside of the network.
To be eligible to enroll in a 2019 Texas Medicare Advantage plan you must have both Medicare Parts A and B and live in the plan’s service area. People with End-Stage Renal Disease (permanent kidney failure) generally cannot enroll in a Medicare Advantage Plan.
You must continue to pay your Part B premium and generally pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join. Some may have a $0 premium.
Texas Medicare Advantage PPO Plans have to cover all of the services that Original Medicare covers except for hospice care. Original Medicare will cover hospice care even if you are in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you will always be covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.
Most Medicare Advantage PPO Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for both the plan’s medical and prescription drug coverage.
Medicare Advantage PPO plans provide another managed-care option for beneficiaries who want greater provider flexibility. With a PPO plan, your out-of-pocket costs will generally be lower if you use doctors and hospitals in the plan’s preferred provider network. You may also choose to use out-of-network providers, but your copayment and coinsurance costs may be higher.
PPOs don’t require members to have primary care doctors, and referrals aren’t needed before seeing a specialist. If you prefer the convenience of getting specialist care directly, without needing a referral from a primary care physician, this may be one factor to consider when choosing between an HMO or PPO plan.
Like HMOs, you can get Medicare prescription drug coverage through your PPO plan by enrolling in a Medicare Advantage Prescription Drug plan. Keep in mind that not every PPO plan includes prescription drug benefits, and costs and benefits may vary by plan.
Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.
Choosing the Right Medicare Advantage Plan
There’s a lot to consider when deciding which Medicare option is right for you. Here are some questions to ask during the decision-making process:
- How much is the premium?
- Will you need to satisfy a deductible or pay copayments or coinsurance? Medicare Advantage plans have an annual cap on how much you pay for Part A and Part B services. This will differ among plans.
- Does the plan cover the additional benefits or services you need (such as coverage for vision, hearing, dental, or health and wellness programs)? Does the plan offer prescription drug coverage (most Medicare Advantage plans do)?
- Do the healthcare providers you normally see participate in the plan?
Sarah began working in the healthcare industry in 2001, where she worked for many years with elderly Alzheimer and Dementia patients. From there she worked as a Group Benefits Administrator with a local healthcare company in the Human Resource Department for a period of 10 years. Since then, she has decided to work in the Medicare insurance industry full time and has joined the family business, Ashford Insurance, as a Medicare Insurance Agent.
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* A licensed sales agent may call or e-mail as a result of completing the information to discuss Medicare Advantage, Prescription Drug Plans or Medicare Supplement Insurance.