Medicare PPO Costs

All Medicare Plans will cost varying amounts depending on your health. PPO plans will also cost more depending on what kind of provider you see. In-network providers will cost less out-of-pocket than out of network providers.

What is included in the plan will also influence the cost. Here are some of the variables that will affect the cost of a Medicare PPO Plan.

  • The Plan includes Part D, Prescription Drug coverage. If it doesn't, add additional costs for a Part D Plan.
  • The PPO Plan's monthly premium. How does this premium compare to Part B premiums?
  • Standard plan co-payments, both in and out of network.
  • Yearly deductible.
  • Any additional deductibles.
  • Total yearly out-of-pocket limits.
  • Plan rates for non-preferred providers.

The costs of each PPO Plan may be more or less than Original Medicare. Because there are so many variables it is very difficult to determine which plan will be cheaper in the long run.

One thing you can do to help estimate this calculation is to collect your bills from the previous year. Add them up and then call the plan and the providers you used and ask them if they will pay the same, more or less using the new PPO plan.

A good office accounts manager should be able to answer these questions on the providers end.

An insurance agent should be able to answer your questions from their perspective.

Once you have done this it should be possible to add up what you are currently paying for Original Medicare and compare the services that you use most often. In addition, if you know a large medical bill is looming on the horizon (like hip surgery) carefully compare Original Medicare with the PPO Plan. Remember that Extra Help is also available for individuals that are worried about meeting their Medicare obligations. Call 1-800-MEDICARE (1-800-633-4227) TTY Users: 1-877-486-2048 and ask to speak to a representative about getting Extra Help.