What’s the difference between Medicare Advantage PPO and PFFS plans?
Awees asked:
Why do some medicare advantage PPO plans say any doctor, but for more savings choose a plan doctor?
why does my primary doctor and preferred Hospital choice accept Blue Cross PPO, but not BlueCross Medicare PPO?
MCCANN
Why do some medicare advantage PPO plans say any doctor, but for more savings choose a plan doctor?
why does my primary doctor and preferred Hospital choice accept Blue Cross PPO, but not BlueCross Medicare PPO?
MCCANN
By Zarnev, March 11, 2008 @ 10:14 am
PPO plans have a network. You can go to a doctor outside of the network but your costs will be higher. For example, if you have an in network primary care doctor co-pay for $10 you might have to pay $20 if you go out of the network. Also, be aware that some Medicare Advantage PPO plans also have a deductible ($500 is a common deductible) if you go outside of the network.
PFFS plans do not have any networks at this time. You can go to any doctor that accepts Medicare but the doctor must be willing to accept the plans payments and terms. The doctor can selectively decide at any time and with any one not to accept the plan. For example, you and your spouse could be on the same plan; the doctor can agree to accept you but not your spouse, even if he accepted your spouse yesterday.
By Ed Atun, March 12, 2008 @ 5:14 pm
There is almost no difference. Doctors stop accepting any provider or plan who was slow to pay them. Your doctor will stop the PPO next because the reimbursement rates have been lowered a lot..