Medicare - Medicare PPO Plans

What are the costs of being in a Medicare PPO Plan?

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In a Medicare PPO Plan, you pay the following:

  • The monthly Medicare Part B premium ($96.40 or $110.50 in 2010)
  • A monthly premium that includes coverage for Part A and Part B benefits, prescription drug coverage (if offered), and extra benefits (if offered) above the Medicare Part B premium
  • Any plan deductible, coinsurance, or copayment amounts that the plan charges. For example, the plan may charge a set amount (copayment) of $10 or $20 every time you see a doctor.
  • A maximum amount (cap) you have to pay for out-of-pocket costs for both in- and out-of-network care in a Regional PPO. In a local PPO, the PPO Plan may or may not choose to have a cap.
Example: Mrs. Smith is thinking about joining a Medicare PPO Plan. The PPO Plan has a $75 monthly premium, but covers additional benefits the Original Medicare Plan doesn’t cover. To be in the plan, Mrs. Smith would have to pay the monthly Medicare Part B premium ($96.40 or $110.50 in 2010) and the additional monthly premium ($75) the plan charges. This plan also charges $10 for every doctor visit. If Mrs. Smith goes to her in-network doctor three times in one month, she would have to pay $96.40 to Medicare, $75 to her PPO Plan, and $30 ($10 per visit) to her doctor for that month. Her total costs for that month would be $201.40 ($96.40 + $75 + $30).