Medicare Advantage PPO

Medicare Advantage PPO

Our goal here at Ashford Insurance is to ensure you understand your options in the Medicare marketplace. We know that this can be a very tedious endeavor and every individual is different; having access to major carriers is the only way to determine what level of coverage will best suit your needs.

Medicare is a federal health insurance program that pays most of the health care costs for people who are 65 or older. It will also pay for health care for some people under age 65 who have disabilities.

A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s Network.

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 that are approved by Medicare.

You can get your Texas 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 an RPPO, you pay less if you use doctors, hospitals, and other healthcare 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 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.

About PPOs

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.

Confused?  Many People Are. It can seem overwhelming when trying to plan your future coverage and sort through the many options, especially since the choices you make can have a significant effect on your health care and your financial well-being.

Whether an “all-in-one” Medicare Advantage plan or a standalone Part D plan suits you, Ashford Insurance can help. Get a quote for prescription drug plans online now at no cost to you. Or, let one of our licensed agents review your options and find the best drug insurance plan for your unique needs. Just give us a call today at 817-952-3153.

Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.