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Medicare PPOs

Medicare PPOs, or Preferred Provider Organizations, are private health plans, much like Medicare HMOs. HMOs and PPOs differ in two key ways:
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  1. Medicare PPOs cover some of the costs of your care if you use doctors and hospitals outside the network.
  2. Medicare PPOs generally do not require that you see a primary care physician before going to a specialist.

​Regional PPOs became available under Medicare in 2006. These plans are similar to local Medicare PPOs, but serve a larger geographic area (either a single state or multi-state area) and must offer the same premiums, benefits, and cost-sharing requirements to all beneficiaries in the region. Regional Medicare PPOs offer all Medicare benefits, including the prescription drug benefit. These plans often but not always have a single deductible for hospital and physician services and an annual out-of-pocket limit on cost sharing for benefits covered under Parts A and B of Medicare. Keep in mind that the out-of-pocket limit will vary depending on the plan you select. As with local PPOs, individuals who sign up for a regional PPO will typically pay more if they go to providers outside of the network.

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  • Home
  • Medicare
    • Medicare Basics
    • Medicare Part D
    • Medicare Advantage Plans
    • Medicare Supplement Plans
  • Long Term Care Insurance
  • Life
  • Dental
  • Contact
  • Additional Insurance Solutions
    • Short Term Medical Insurance
    • Supplemental Hospital Insurance
    • Accident and Critical Illness Insurance
    • Health Discount Program
  • Marketplace Health Insurance
  • Marketplace Health plans