Texas Medicare PPO Plans are private Medicare Advantage plans. When you join a Texas Medicare PPO, Medicare pays the Medicare Advantage company to deliver your Medicare benefits to you. You must be enrolled in both Part A and B, and live in the plan service area to be eligible.
As a Medicare Advantage PPO member, you will generally get your medical care from the network doctors and hospitals. If you need to go outside the network, you will still have some coverage for out of network services. Unlike an HMO, you do not have to choose a primary care doctor. You can see any provider on the Medicare PPO’s network, and you will generally pay a copay for each medical service.
Medicare PPO Advantage plans are not Medicare supplements. They work differently.
Medicare PPOs are offered by several insurance carriers in Texas, which varies by county. Medicare PPO plans generally have a monthly premium which you will pay for the plan. Certain plans include the Part D prescription drug card.
A Tip About Medicare PPOs
Enrollment into a Texas Medicare PPO plan is generally for the entire year, unless special circumstances occur in which Medicare will allow dis-enrollment. Some plans have small networks or expensive cost-sharing for certain services. For this reason, it’s important to work with an agent who can properly explain the plan’s rules to you. Also the plan’s benefits, formulary, pharmacy network, provider network, premium and/or copayments and coinsurance may change on January 1 of each year.
To learn about Texas Medicare PPO plans available in your county, call us today or fill out our online request: