Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her?
a. In general, Mrs. Ramos will need a referral to see specialists.
b. In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare but will have to pay the difference between the plan’s allowed amount and the provider’s usual and customary charge.
c. Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis, whether they will treat her.
d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network.
A Medicare Advantage PPO (Preferred Provider Organization) plan offers a network of healthcare providers, and members generally pay less when they use these in-network providers. However, they still have the flexibility to use out-of-network providers, but this typically comes with higher out-of-pocket costs.
d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network.
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