Choosing the right health insurance plan for you or your loved ones can be overwhelming. If you or someone you know is 65 or older and looking for cost-effective health insurance options, you’ve come to the right place. We’ve put together this simple guide to help you figure out if Medicare Advantage PPO is the right way to go. Learn what Medicare Advantage coverage is, what the difference between PPO and HMO is, who is eligible and which option is right for you.

WHAT IS MEDICARE ADVANTAGE?

Medicare Advantage, or Medicare Part C, is an all-in-one health plan offered by private, Medicare-approved insurance companies that includes Medicare Part A, Part B, and usually Part D benefits. Let’s look at the coverage breakdown for each:

Part A

Medicare Part A covers hospital expenses (i.e. surgery, lab tests), home health care, and hospice.

Part B

Medicare Part B covers outpatient medical care such as doctor visits, x-rays, bloodwork and other preventative care services. 

Part D

Medicare Part D (also known as PDPs) covers prescription drugs and associated costs.

Medicare Advantage plans combine medical insurance and prescription drug coverage all in one affordable health insurance plan, and also allows you access to additional benefits that traditional Medicare doesn’t cover, such as dental and vision. 

ELIGIBILITY AND ENROLLMENT

To qualify for Medicare Advantage plans, you must first qualify for or be currently enrolled in Medicare Part A and Part B coverage and live within your service plan’s area. Most people automatically qualify for Medicare Part A and Part B when they turn age 65 or have received two years of disability benefits from the Social Security Administration or Railroad Retirement Board. Once you’re eligible, then you can join Medicare Advantage for the first time or make changes to your existing plan during three designated enrollment periods:

• Initial seven-month enrollment period (IEP): the three months before your 65th birthday, your birthday month, and the three months after your 65th birthday
• Annual enrollment period (AEP): October 15th to December 7th every year
• Special enrollment period (SEP): special time period based on life changes — i.e. moving out of service coverage area, losing employee coverage, etc.

THE GREAT DEBATE: HMO VS. PPO

Medicare Advantage works like conventional PPO and HMO options, that differ mainly in cost, size of the plan network, ability to see specialists, and out-of-network coverage. So, which option is best for you? 

Medicare Advantage HMO

Medicare Advantage HMO combines all the benefits that come with a Medicare Advantage plan along with a traditional Health Maintenance Organization (HMO) plan. With HMO, you’re only able to seek care from doctors and medical facilities from a pre-approved in-network list. In addition, you must choose a primary care physician (PCP), and if you need to see a specialist, you must first get a referral from your chosen PCP. Although your choices are limited, the biggest benefit of Medicare Advantage HMO is the low (or sometimes no) monthly premiums, copays and deductibles.

Medicare Advantage PPO

On the other hand, a Medicare Advantage PPO (Preferred Provider Organization) plan allows you to choose from a complete list of in-network healthcare providers. Additionally you are not required to choose a primary care physician or get referrals to see a specialist. Although PPO plans can sometimes be a little more costly than HMO plans, you and your loved ones have the freedom to choose out-of-network healthcare providers and specialists.

Although both HMO and PPO plans include a convenient medical and prescription coverage in one, PPO is typically the preferred Medicare Advantage choice due to the wide range of doctors and care providers available to you. With more choices, rest assured you and your loved ones are covered with the best healthcare possible. 

APPLY OR ENROLL FOR MEDICARE ADVANTAGE PPO TODAY

If you’re looking for a comprehensive but cost-effective health insurance plan for you or a loved one 65 or older, Medicare Advantage PPO is the right way to go. Take this guide into consideration when applying or enrolling in a Medicare Advantage plan for you or your family member. Apply or enroll today!