The Advantage of Medicare Advantage PPO Plans
You know that PPO insurance plan you may have had when you were working? A Medicare Advantage PPO plan works a lot like that. A PPO plan allows you the freedom to choose your healthcare provider. If you’ve had an HMO plan, oh wow, you are really going to love a PPO plan.
- Medicare Advantage PPO plans let you see doctors inside or outside a network†.
- You usually do not need a referral to see a specialist with these plans.
- PPOs are flexible, making them a great choice if you want to pick your own providers.
How Does a Medicare Advantage PPO Plan Work?
Let’s discuss a PPO plan and how it works. If you’re unfamiliar with the term PPO or just need a refresher, it stands for preferred provider organization. A PPO plan provides healthcare coverage with a network of healthcare providers and hospitals. Insurance companies have an agreement with the care providers in the network, making it more affordable to visit one of these providers.
The Freedom to Choose Your Doctor With a PPO
Its flexibility is what makes it a popular choice for a Medicare Advantage (Part C) plan. While a PPO plan has a network of care providers, you are not limited to that network, meaning you can choose a healthcare provider outside of the network. You just may have to pay a little more to see a provider who is out-of-network. Some companies who offer PPO plans have large networks so it’s not often difficult to find a provider that you like.
Another advantage of a PPO is that most plans don’t require a referral to see a specialist. This can make it easier to get the specialized care you need. A PPO plan is a great choice as your Medicare Advantage plan, but it is not the only type of plan available.
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Comparing PPO and HMO plans
Differences in Provider Flexibility
| Provider Flexibility | |
|---|---|
| PPO | Visit any healthcare provider of your choosing†. Providers out-of-network may cost more. |
| HMO | See a healthcare provider in the network. Providers out-of-network could require you to pay the whole bill (except in emergency situations)†. |
Differences in Cost and Referrals
| Cost | |
|---|---|
| PPO | Visiting a provider out-of-network generally costs more. |
| HMO | Care costs are generally slightly lower, depending on the plan and benefits. |
| Referrals | |
|---|---|
| PPO | Generally, not required. |
| HMO | May require a referral from your primary doctor to visit a specialist. Note: many people prefer PPO plans to avoid this. |
What to Consider When Choosing a Medicare Advantage Plan
Having access to certain healthcare providers is a major consideration when choosing a Medicare Advantage plan, whether through the freedom to choose with a PPO or with an HMO network but it should not be the only thing you consider when choosing a plan. Here are some additional things to think about when choosing a plan:
- Coverage details like are my prescription drugs included.
- Premiums and healthcare costs such as coinsurance and copays
- Supplemental benefits like dental, hearing, and vision
- Maximum annual out-of-pocket expenses
- Additional rewards that can be earned or OTC allowances offered
Finding the right Medicare Advantage plan doesn't have to be a solo project. While you should consider your budget and lifestyle, you can also speak directly with an actual human licensed Clover Health agent at 1-800-836-6890. We’re ready to walk you through the options in your county and answer any questions you have.
If you value flexibility and access to a broad provider network, a Medicare Advantage PPO plan may be a strong fit.
About the Author
The Clover Health Editorial Team creates easy-to-understand Medicare content to help people learn about their coverage and options. Our articles are written and reviewed by licensed insurance experts, healthcare writers, and Clover's clinical specialists. Every article is checked for accuracy, clarity, and CMS compliance.
Sources:
†Out-of-network/non-contracted providers are under no obligation to treat Clover members, except in emergency situations. ** Mayo Clinic “When to See a Specialist: Signs You Shouldn’t Ignore”.
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