What Happens If My Medicare PPO Coverage Ends?

Medicare Preferred Provider Option Plans (PPOs) are one type of Medicare Advantage Plan; other types are private-fee-for-service plans (PFFS) and health maintenance organizations (HMOs). Medicare Advantage Plans in 2011 have been forced to give Medicare patients a prescribed network of doctors, something that the majority of PPOs already do. Since Medicare PPO plans have been forced to provide a network of doctors, some coverage plans will end this year. If you have a Preferred Provider Option plan (PPO), your insurance plan could expire. It is important to know not only the nature of the next step, but also how to take the next step to become reinsured as soon as possible.

Can Medicare PPO Coverage End?

Medicare PPO coverage can come to an end. Insurance plans simply have the right to expire and discontinue offering benefits to patients. Often, Medicare plans shut down when governmental regulations force plans to adhere to rules and guidelines they do not desire to obey. While it may seem easy for insurance plans to expire, it is not a cakewalk for patients who must make new decisions about insurance plans and medical expenses.

What Happens if Medicare PPO Coverage Ends?

Medicare plans usually leave the Medicare program at the end of the year. If a Medicare plan chooses to leave the Medicare program, the plan will send a letter of notice to the patient, announcing the plan's departure from Medicare. If the patient does nothing as a result of your plan's departure, he/she will automatically be returned to the Original Medicare program. If the patient had a Medigap policy under Original Medicare, he/she will be allowed to use this plan once more. If the did not have a Medigap policy, he/she will be allowed to buy a policy. If the PPO plan included Prescription Drug Coverage, that can also be purchased without penalty. A member could also enroll in another PPO plan that has Prescription Drug Coverage, or buy an independent Prescription Drug Coverage Plan. If you return to Original Medicare and want a Prescription Drug Plan, you will need to buy Prescription Drug Coverage under Part D.

Very few Medicare Advantage plans have departed from Medicare in past years. However, with medical insurance, you should always prepare for the worst and expect the best.