PPO Plans
Preferred Provider Organization (PPO) plans are a type of Medicare Advantage Plan provided by private insurance companies. Like other advantage plans, PPO plans have a network of providers, doctors, and hospitals that beneficiaries can use to receive their care.
Benefits
While PPO plans do have a network, beneficiaries can go outside the network to receive care if they choose to. However, keep in mind that you will pay much less by using in-network providers. Those with a PPO plan also do not have to select a primary care doctor or get referrals for specialists. This is one of the greatest benefits of PPO plans as they provide more flexibility than HMO plans.
PPO plans provide the same coverage as Original Medicare, which includes hospital and medical insurance. However, the extra benefits you would receive with a Medicare Advantage plan will ultimately depend on the area you live in and the plan providers. Some of the extra benefits you can receive include:
- Dental care
- Vision care
- Hearing care
- Prescription drug coverage
- Fitness memberships
- Nutrition programs
- Wellness programs
- Transportation
- Adult daycare services
Eligibility and Enrollment
To enroll for Medicare Advantage PPO plans, you must be enrolled in Original Medicare. There are several enrollment periods you can take advantage of to enroll:
- Initial Enrollment: Your IEP begins three months before your 65th birthday and ends three months after your 65th birthday. This period is the best to enroll in and is highly encouraged so enrollees can avoid late enrollment penalties. However, if you are under 65 and receive Social Security disability, you can qualify for Medicare during the 25th month after you begin receiving these benefits. You can then enroll in a Medicare Advantage Plan three months before becoming eligible.
- Annual Enrollment: AEP begins on October 15 and ends December 7. During this period, beneficiaries can review their coverage and make changes if need be; this includes enrolling in a Medicare Advantage Plan or switching advantage plans.
Special Enrollment: Certain situations can trigger a SEP that will allow beneficiaries to enroll in a new plan. For example, you can enroll in a Medicare Advantage Plan if you moved out of your plan’s service area or lost your coverage.
Should I Get Medicare Advantage?
Medicare Advantage Plans may not be right for everyone. However, if you enjoy having the same coverage as Original Medicare while also getting additional benefits that would not be covered with Original Medicare, then a Medicare Advantage Plan might be something to consider.
Give us a call today at 512-432-5414 for more information about Medicare Advantage Plans. We can walk you through each plan and help you determine the coverage you need.
