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Medicare Advantage – PPO Plans

The two most popular types of Medicare Advantage plans are PPO and HMO plans. The difference here is mainly about how much flexibility you have to see healthcare providers who are NOT in your plan’s network.

Key Traits of a PPO plan

Medicare Advantage PPO plans usually have the following qualities:

1. No Referrals Needed

Most PPO plans do not require you to get a referral from your Primary Care Physician (PCP) in order to go to a specialist. This is a huge deal for people who don’t like asking permission to see a specialist that they prefer.

2. Coverage for out-of-network providers

When you go out of network on a Medicare Advantage PPO plan, it will likely cost you more than if you were to go IN network, but you’ll still get at least partial coverage. This is a big difference from an HMO plan, which will have 0% coverage out of network. PPO plans differ greatly on how much they will make you pay for out of network coverage, however. Some have a fixed co-pay that will be slightly higher than you in-network co-pay (think $40 specialist visit vs. $30 specialist), but some plan will charge you a co-insurance.

Example: In-Network Specialist charges you $30 vs. out-of-network specialist charges you 40%).

To learn more about Medicare HMO plans, click here.

Medicare sure can be confusing, huh? We made a video that goes through Medicare step-by-step. This is the easiest way to learn. Check it out!