What Is Medicare Advantage PPO? Understanding the Coverage and Benefits

As people age, they generally start to require more healthcare services. It is just a reality of life and something most or all of us will go through during our twilight years.

For more than a half-century, most seniors have relied on Medicare to fund their increased healthcare needs. Approximately 60 million people now take advantage of this essential federal program, and it stands as one of the more popular public services offered by any agency in Washington.

For most people who are 65 and up, signing up for the basic Medicare benefits is a no brainer. Many eligible candidates also chose to enroll in a Medicare Advantage PPO plan, which is a way to expand and improve the standard offerings.

What exactly is a Medicare Advantage PPO plan? Why should you want one? How is it different from an HMO? And who does this type of plan benefit the most? The following breakdown will help explain it all.

What Is Medicare Advantage PPO?

For many people, standard Medicare coverage proves sufficient. Medicare Part A will protect you for inpatient care in the event of an emergency procedure. And Medicare Part B offers a type of outpatient care that should cover the majority of your needs.

But a Medicare Advantage PPO plans provide even broader coverage, specifically for prescription drugs and vision, dental and hearing screenings. By supplementing the standard plans, you get everything that the average person will need on a day-to-day basis or to cover an accident — plus even more.

Why Should You Want a Medicare Advantage PPO?

No rule is absolute. But here, as in almost everything, more is usually better. Medicare Advantage PPO is additional coverage and can bring many prescription drug copays down to $0. What’s not to like?

It also offers clear benefits over an HMO plan. While an HMO can be cheaper, you lose a lot of flexibility when it comes to choosing your doctors. PPOs in general allow you to go out of network and also go directly to a specialist without a referral — neither of which are permitted by most HMOs. And in this instance, the coverage dramatically reduces drug costs.

Better still, this type of plan usually is very cost-effective for the extra benefits that you receive. In short, you pay a little more, yes. But what you get — especially in terms of mental security — is a lot more.

Who Benefits Most from Medicare Advantage PPO?

The people who get the most out of a Medicare Advantage PPO is anyone who takes prescription medication. Medicare Part A and Part B do not offer full coverage for drugs — even when your doctor says you have to take them.

At that point, the math becomes pretty simple. If you only fill one prescription per year, then this extra coverage may not be worth the extra cost.

But for anyone who takes medication regularly, and especially anyone who takes a lot of medication, the savings will be clear. And you’ll also receive the peace of mind for the future if you need to take something new or up your dosage.

Taking Advantage

There are many options when it comes to health insurance. Even within the umbrella of Medicare plans, you have many different choices. You want to make sure you get the plan that's best suited for your needs.

Naturally, nobody wants to spend more than necessary. But sometimes the costs of added stress can do even more damage and you really do get what you pay for. So you may be among the millions of people out there who can benefit greatly from Medicare Advantage PPO plan.