What Is a PPO?

When it comes to your health insurance, you have a lot of options. And one is a Medicare Advantage PPO plan. A PPO, or Preferred Provider Organization, is a type of health insurance plan that gives you the ability to choose your healthcare provider – whether or not they are in network. This flexibility lets you get care from a wider range of providers and access specialists without needing a referral. But is it right for you?

We’re here today to take a closer look at PPO plans – how they work and whether they meet your healthcare needs. Let’s get started.

How a Medicare Advantage PPO Plan Works

A Medicare Advantage PPO plan works similarly to other Medicare Advantage plans but gives you more options in your choice of healthcare providers. This flexibility can be helpful for people who may need care from specialists who don’t fall within the network or those who just want more choice. Here’s a closer look at what you need to know.

PPO Costs

Although PPO plans are more flexible, they do involve extra costs. Generally speaking, a PPO plan comes with higher monthly premiums, deductibles and copays than an HMO. But there are ways to reduce costs. Using your PPO’s in-network doctors and providers can help save you money.

Provider Network

As the name suggests, PPO plans come with network of preferred providers – including doctors, hospitals and other healthcare facilities. Typically, you’ll pay lower out-of-pocket costs for any in-network services you receive. Choosing a provider that’s out-of-network may result in additional costs, but unlike with an HMO plan, you won’t need a referral.

Primary Care Provider

A primary care provider (PCP) serves as a central point of contact for managing your healthcare needs. They will also be the one you turn to for routine check-ups, preventive care and common health issues. Unlike an HMO (Health Maintenance Organizations), PPO plans don’t require you to select a PCP. But having one can still be beneficial. A PCP who knows your medical history can serve as a trusted advisor, helping to ensure continuity of care. Plus, you can enjoy the ability to see specialists without needing a referral.

Is a PPO Plan Right for Me?

Whether or not a PPO is right for you largely depends on your individual circumstances. Where you live, how much you travel, your choice of doctor and your personal budget will all impact your decision. And while an HMO plan may offer you some cost savings, they do require you to choose your care within the specific plan’s network.

Regardless of whether you choose an HMO or a PPO, it's important to review the specific details of each plan. Consider the provider network, coverage for out-of-network services and additional benefits offered. That way, you’ll make sure you’re getting a plan that best aligns with your healthcare needs and preferences.

Enrolling in a Medicare PPO Plan

Once you've found a PPO plan that meets your needs, you can enroll during specific enrollment periods. Those include the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP) or Special Enrollment Period (SEP) if you qualify. Want to know more? Contact us today for help with your Medicare PPO options to learn more about a Wellcare Medicare Advantage Plan that’s right for you.