Question:
Question from Mike: I met with a Medicare agent who told me a PPO Advantage Plan would work just like a Supplement and provide me access to doctors and hospitals all over the country. Is that accurate?
Answer:
No. That is 100% false and a statement that is often made in error by agents and brokers or with the intent of being purposely misleading.
PPOs all have networks. Although there are a limited number of plans that provide national “in network” access to many (but not all) doctors and hospitals, most have regional networks.
The PPOs that have regional networks give members the “freedom” to get care out of network, but only under a couple of very important conditions: 1) Out of network providers are under no obligation to accept a PPO except for Emergency Room services. More and more hospitals and health systems, such as the Mayo Clinic, have a policy to accept zero out of network PPOs for elective consultations, treatment, surgeries, etc. 2) Many, if not most, PPOs have higher co-pays and a Maximum Out of Pocket that can be thousands upon thousands of dollars more for out of network services.
Agents often try to convince people that a Medicare Advantage PPO is a substitute for Supplements. Although a PPO, especially with a national network, can be a great choice for many who want to save money on premiums and get the “extras” such as comprehensive dental coverage and OTC allowances, it absolutely is not a substitute for a Supplement, nor should it ever be presented as such.
When meeting with new clients who are going on Medicare for the first time, the agents at The Health Insurance Store go in depth explaining the differences between Advantage Plans and Supplements. When people decide they’d rather have a Supplement, it’s for two reasons: 1) The ability to use any doctor or hospital in the country that accepts Medicare with no additional out of pocket costs. 2) There are never delays in receiving care or tests because prior authorizations aren’t necessary before getting MRIs, CT scans, surgeries, Physical Therapy, home health care, and many other services. Neither are the case with Advantage Plans, including PPOs.
As I’ve written about numerous times, I’m a big fan of Advantage Plans, both HMOs and PPOs. They’re an integral part of our overall Medicare program. However, they’re not for everyone. But too many agents want to sell them to everyone because they pay much larger commissions than Supplements. This causes agents to be biased and often deceptive or misleading in their sales tactics.
It’s vital that everyone, especially those who are new to Medicare, get both types of plans explained and disclosed correctly, including the pros, cons, risks, and rewards, because the choice that is made when initially going on Medicare Part B has ramifications that can last a lifetime.
With questions regarding this topic or to make an appointment for a no cost consultation, give us a call at 724-603-3403 or email me personally, Aaron@GetYourBestPlan.com.