Senior Educators: PPO Plans

Preferred Provider Organizations, or PPOs, are the managed care organizations that cover more people under 65 than any other type of private health insurance. PPOs have been an option for Medicare recipients for many years and represent the same amount of physician and hospital choice as Original Medicare. Although PPOs are an extremely popular choice amongst Medicare beneficiaries, good PPO plans are not as widely available as other types of Medicare Advantage plans.

How do PPO plans work?

PPOs provide Medicare services through any Medicare physician. There are no referrals required to see specialists with PPO plans. Most PPOs also provide Medicare Part D prescription drug coverage as part of the plan. By law, PPO plans, like all other Medicare Advantage (MA) plans, must be at least as good as Original Medicare.

Which doctors can I see with a PPO?

Everyone in a PPO can see go to any Medicare doctor or hospital for healthcare services. PPOs have a “network” of physicians that provide higher levels of discounts for members, so many people choose to receive most of their services within network providers. Networks differ by company and even by plan, so one consideration of whether a PPO might be right for you is whether the majority of your physicians are “in network.” Unlike HMOs, PPOs do not require referrals to see a specialist.

How do I choose which plan is right for me?

Many people like help deciding which plan is a good choice for them. Plans vary widely from company to company and from place to place, and when comparing plans between companies it’s important to compare the fine print—not just the premiums. That’s what Senior Educators Insurance Services was created for—to provide free, unbiased assistance to Medicare recipients to help them choose appropriate coverage. To request help now, please fill out the short informational form here so a licensed representative can be well informed about your healthcare preferences. Or simply give us a call at 1-800-505-8575 and speak with a trained and licensed representative now!

If you prefer to do the research by yourself, we’ve created a number of tools to help you do so. First, we have created the Senior Educators Insurance Services’ Top 10 Tips for Navigating Medicare, which captures a very high-level perspective on what to consider based on our years of experience. Second, we have created a plan comparison engine that shows you a list of the plans available in your area. To access that tool, enter your zip code on the side of this page and click the “Find Plans” button. We hope that if you find a plan through our tools, you’ll enroll through our organization, as it’s how we can afford to provide excellent, unbiased information and help.