A Preferred Provider Organization (PPO) is a type of managed care organization of doctors, hospitals, and other health-care providers created by a private, for-profit, insurance company. In a PPO, Medicare contracts with a third-party administrator to provide Medicare Advantage, or Medicare Part C, health-care benefits. Unlike a Health Maintenance Organization (HMO), a Preferred Provider Organization usually does not require a you to have a primary care physician and you are free to go to any doctor or medical facility within the PPO network of contracted providers without a referral.
Your Preferred Provider Organizatio (PPO) and Access to Care
You will be encouraged to use providers that belong to the plan’s network. However, you may use doctors, hospitals, and other health-care providers outside th plan’s network at a higher cost. This factor gives you greater flexibility and access to care than an HMO plan.
Many PPO plans offer prescription drug coverage. PPO plans my also come with extra benefits such as dental, vision, and hearing, but you may have to pay for these extras.
Something important to know, not all PPOs include a drug plan. If your PPO does not, you are not eligible to enroll in a stand-alone Prescription Drug Plan (PDP). If you do, that enrollment will automatically dis-enroll you from your PPO plan and will be returned to original Medicare.
The maximum out-of-pocket amount allowed by the government for these plans is significantly higher than in an HMO. In an (HMO), the maximum allowable out-of-pocket cost in 2020 is $6,700. However with a PPO, while in-network costs are capped at $6,700, your out-of-network copays and coinsurances may not be capped until you have spent $10,000.
We represent the top providers in the nation and are able to help you compare and contrast the access to care vs the cost of an HMO or a PPO. For a free consultation to help determine the best plan for your particular medical and financial situation, call us at