Each plan has a list (called a “network”) of doctors, hospitals, and other providers that you may go to.
Each plan gives you flexibility to go to doctors, specialists, or hospitals that aren’t on the plan’s list, but it will usually cost more.
You may get care from specialists without a referral or prior authorization from another doctor. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.
Each plan may choose to offer a discount to members if they voluntarily use preauthorization or if they pre-notify the plan when getting out-of-network services.
You get all services covered under Medicare Part A and Part B, although the amount you pay for these services might not be the same as under the Original Medicare Plan. Each plan can charge you a monthly premium amount above and beyond the Medicare Part B premium.
Each plan can charge deductible and coinsurance amounts that are different than those under the Original Medicare Plan.
In a Regional PPO Plan, you have an added protection for Medicare Part A and Part B benefits. There is an annual limit on your out-of-pocket costs. This limit varies depending on the plan. Medicare PPO Plans operate like Health Maintenance Organizations (HMOs) except in HMOs you can only go to doctors, hospitals, and specialists that are part of the plan’s network, and often HMOs require referrals and pre-authorizations.
