H3256 001 04 - Local Ppo (2024)

FAQs

What is the difference between a PPO and a local PPO? ›

PPO plans typically offer fixed copayments when you use the plan's network. There are two types of Medicare PPO plan: Regional PPOs, which serve a single state or multi-state areas determined by Medicare. Local PPOs, which serve a single county or group of counties chosen by the plan and approved by Medicare.

You'll keep your Medicaid plan, and you'll still get all the same Medicaid benefits you get now. A dual health plan is a type of Medicare Advantage plan. It will replace your current Medicare plan. Plus, it includes prescription drug coverage and many other benefits and features you don't get with Original Medicare.

UnitedHealthcare Non-differential Preferred Provider Organization (PPO)

In general, PPO plans tend to be more expensive than an HMO plan. Your monthly premium will be higher and you will have to meet your deductible before your health insurer starts paying. You will also have to pay more out-of-pocket if you visit a provider who is not part of your PPO network.

An HMO is a good choice if you want the cheapest health insurance and don't mind staying within the plan's provider network. A PPO would probably be the better option if flexibility is what you prefer, even if it means higher health insurance costs. Out-of-network care? Need to name a primary care physician (PCP)?

A type of medical plan in which coverage is provided to participants through a network of selected health care providers, such as hospitals and physicians.

However, if you've already got a health plan and don't know which plan type you have, you can check your insurance card or contact your insurance provider directly. If you have an online account through your provider that allows you to access plan details, you can also start there.

HMO PlansWith most plans, you'll need to choose a PCP. This PCP is your main health care contact and care is often coordinated through them. You may need to get a referral from your PCP to see a specialist. PPO PlansIt's less likely that you'd need to choose a PCP and less likely to need a referral to see a specialist.

PPOs Usually Win on Choice and Flexibility

If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.

PPO insurance plans allow plan participants to choose from a larger network of doctors and hospitals without needing a referral to see a specialist. While PPO plans allow for out-of-network care, they tend to have higher monthly premium costs and annual deductibles than other types of health insurance plans.

What is PPO type? ›

Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan's network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

Restrictive networks

In some cases, you'll have a higher share of costs when you see an out-of-network doctor. In other cases, you're not covered at all if you go out of network. This is particularly important if you travel a lot because Medicare Advantage plans generally don't provide out-of-state coverage.