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Medicare Advantage PPO Plans

Medicare Advantage PPO plans are offered by private insurance companies. Like other Preferred Provider Organization plans, these have a network of doctors, other health care providers, and hospitals.

You’re not required to use someone within the network. However, if you use this network, you pay less. If you go outside of the network for health care, you pay more.

Benefits you are eligible for will depend on your area and plan providers

What are the benefits of a Medicare Advantage PPO Plan?

If you have looked into an Advantage plan (also known as a Part C plan), you probably know it offers extra benefits Original Medicare doesn’t with little to no additional premium. 

Such benefits can include: 

  • Adult day-care services
  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Over-the-counter drugs
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness programs

Benefits you are eligible for will depend on your area and plan providers. 

However, there are some additional benefits to having a PPO Advantage plan. When you have a PPO, you’re not required to choose a primary care physician and you don’t have to get a referral to see a specialist. 

Also, most PPO Advantage plans include prescription drug coverage. But, again, be sure to check with a licensed Medicare insurance specialist to see what benefits are available in your area.

When can I enroll in Medicare Advantage?

If you are eligible for Medicare, you are eligible for an Advantage plan. But there are specific times in which you can enroll in a Part C plan:

Initial coverage election period — Your initial coverage election period is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that is how you are becoming eligible for Medicare, you can enroll into an Advantage plan three months before your month of eligibility until three months after you became eligible. 

Annual election period — Also known as open enrollment or AEP, the annual election period for Medicare Advantage is October 15 through December 7 every year. Coverage for the Part C plan you choose during this time will begin January 1 the next year. During this time, you can also add, change, or drop current coverage.

Medicare Advantage Open Enrollment Period — During this open enrollment period, you are able to change from one Advantage plan to another or drop it to return to Original Medicare.

Special Election Period — There are several things that can trigger a special election period and they are unique to an individual. It is best to speak to a licensed Medicare insurance agent to find out if you qualify for a special election period. However, there are a few common instances we can talk about. Such as, if you move outside your Medicare Advantage plan’s service area, qualify for extra help (such as a program that helps pay for your prescription drugs), or move into a nursing home you might qualify for a special election period. During this time you can make changes to your Advantage plan or return back to Original Medicare.

What’s the difference between HMO and PPO Medicare Advantage plans?

Honestly, Medicare Advantage HMO and PPO are more alike than they are different. 

But, there are some key differences: 

  • PPOs allow you to let you see doctors outside the plan network, even though it might cost you more in coinsurance or copayments. You can’t go out-of-network with an HMO.
  • You don’t have to choose a primary care provider with a PPO, but you do with an HMO.
  • To see a specialist, you have to get a referral with an HMO. PPOs don’t require one.
  • Because of their flexibility, PPO plans typically have a higher premium

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