PPO stands for Preferred Provider Organization. A PPO is a Medicare Advantage plan that includes a network of healthcare providers put together by your health coverage provider to take care of your health needs.

How does PPO plan work?

All types of doctors, hospitals and clinics sign up with an insurance carrier to offer you the highest quality healthcare coverage available. These providers have agreed to accept the insurance carrier’s fee schedule and guidelines for your medical care. Should you want to see an out-of-network doctor you may certainly do so. Keep in mind, however that the deductible will probably be higher and you’ll probably be asked to pay a larger part of the medical bill. We do this to encourage our members to use the many fine physicians, medical providers and hospitals within our network.

What are the costs?

Each time you visit your doctor, or have a medical service done, you’ll be asked to pay a small co-pay or a percentage of the cost out of pocket. You will usually have to pay more for the services you receive if you go outside the network, and you must follow special rules in order for your insurance carrier PPO to pay for these services.

Who should choose a PPO plan?

If you prefer to pay a smaller monthly premium for your healthcare costs and feel that you will be seeking care within the network of providers than this plan might be a good one for you.

Who is eligible?

You are eligible for a PPO plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with end-stage Renal Disease are generally not eligible to enroll in an insurance carrier’s PPO plan unless they are members of our organization and have been since their dialysis began.