Medicare Advantage PPO plans have a network of doctors, healthcare providers, and hospitals.
However, you are not required to see someone inside the network.
It is important to note that you will pay less if you do receive care in the network, but you are allowed to use outside care and see a specialist without a referral from a primary care provider.
Benefits of a Medicare Advantage PPO plan
Medicare Advantage plans provide your Medicare Part A and B benefits along with some additional benefits including:
- Fitness memberships
- Nutrition programs
- Over-the-counter drugs
- Services for those with chronic conditions
- Transportation to healthcare appointments
- Wellness programs
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What’s the difference between PPO and HMO?
Both PPO and HMO Medicare Advantage plans have a network of providers.
PPOs allow you to see doctors outside of the network. However, it is cheaper to see in-network providers. HMOs only allow care outside of the network in case of emergency.
HMOs require you to choose a primary care provider and get referrals from them to see a specialist. PPOs do not require either.
Because of the restrictions, PPOs are cheaper. HMOs allow for more freedom of choice, but have a higher premium.
When to enroll in Medicare Advantage plans
You can enroll in Part C when you first get Medicare. Medicare’s initial enrollment period is three months before you turn 65 and lasts until three months after.
There is also an annual election period and an open enrollment period in which you can get an Advantage plan.
Medicare’s annual election period, or AEP, begins October 15 and runs through December 7 every year.
Medicare Advantage’s open enrollment period is from January 1 through March 31.
During this time you can switch to another MA plan or disenroll and go back to Original Medicare.
There are also special election periods.
These are triggered qualifying life events that allow you to make changes to your Medicare health coverage immediately.
Some examples that would qualify you for a special election period include unintentional loss of coverage, getting married, and moving out of your current plan’s area. But there are many things that would trigger a special election period.