PPO costs and coverage - Medicare Interactive (2024)

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PPO plans are typically more expensive than other plan types. Not only will your plan premium be higher, but you'll also have to meet your annual deductible before your insurance company kicks in its share.

Preferred Provider Organizations (PPOs) Medicare.

Although the Centers for Medicare & Medicaid Services (CMS) is the agency in charge of the Medicare program, Social Security processes your application for Original Medicare (Part A and Part B). We provide general information about the Medicare program and can help you get a replacement Medicare card.

If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

HMO plans might involve more bureaucracy and can limit doctors' ability to practice medicine as they see fit due to stricter guidelines on treatment protocols. So just as with patients, providers who prefer a greater degree of flexibility tend to prefer PPO plans.

What is better than PPO? ›

The monthly payment for an HMO plan is lower than for a PPO plan with a comparable deductible and out-of-pocket maximum. CareFirst's PPO plans offer a wide network of providers. In exchange for a lower monthly payment, an HMO offers a narrower network of available doctors, hospitals and specialists.

More flexibility

Unlike an HMO , a PPO offers you the freedom to receive care from any provider—in or out of your network. This means you can see any doctor or specialist, or use any hospital. In addition, PPO plans do not require you to choose a primary care physician (PCP) and do not require referrals.

Restrictive networks

In some cases, you'll have a higher share of costs when you see an out-of-network doctor. In other cases, you're not covered at all if you go out of network. This is particularly important if you travel a lot because Medicare Advantage plans generally don't provide out-of-state coverage.

Medicare Advantage PPO plans are a popular Medicare option for enrollees who are looking for more provider freedom than an HMO plan can offer. PPO plans offer cost savings when using in-network providers, but these costs can quickly add up when out-of-network providers are used.

There are two types of Medicare PPO plan: Regional PPOs, which serve a single state or multi-state areas determined by Medicare. Local PPOs, which serve a single county or group of counties chosen by the plan and approved by Medicare.

Wherever you are on your Medicare journey, you likely have lots of questions. This is where AARP can help. Join us for a free informative webinar focused on common Medicare questions, so you can make the right choices and avoid costly mistakes.

The processing time for Medicare Part B applications typically ranges from one to three months, starting from when the Social Security Administration receives your application. It's best to apply as early as possible, especially if you're nearing your 65th birthday or the end of your Initial Enrollment Period.

To calculate the Medicare tax: Employee's gross pay x 1.45% = Medicare tax contribution.

Your plan will mail you an EOB each month you fill a prescription, visit a health care provider, or file a claim. This notice gives you a summary of your claims and costs.