MediBlue PPO | New York Medicare Advantage PPO Plans | Empire Blue
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Empire MediBlue PPO

Medicare Advantage plans bundle all the benefits of Medicare Part A and Medicare Part B into one convenient plan. Plus, these plans often have extras, such as coverage for prescription drugs, vision, dental, and hearing aids.

A Medicare Advantage PPO plan is a Part C plan that works like a Preferred Provider Organization (PPO) plan. Empire MediBlue PPO is a  Medicare Advantage plan that gives you the flexibility to work with any doctor or specialist, in or out of network, no referrals needed. If you choose to see a provider outside your plan, your costs may be higher.

Are all Medicare Advantage Plans PPOs?

A Medicare Advantage PPO plan is one type of Medicare Advantage plan. Keep reading to see if it’s the right fit for you.

Medicare Advantage Plan

A Medicare Advantage plan, also known as a Part C plan, conveniently bundles all the benefits of Parts A and B. Most plans also include Part D (Prescription Drug) coverage.

Preferred Provider Organization (PPO)

When you choose a Preferred Provider Organization (PPO) plan, you choose a primary care physician (PCP) for check-ups. You don’t need a referral if you need to see a specialist or want to see another doctor. You can see doctors who are out of network but you may pay more.

Medicare Advantage PPO Plans

A Medicare Advantage PPO is both a Medicare Advantage plan and a PPO. Empire MediBlue PPO is one type of Medicare Advantage plan that combines the benefits of a Medicare Advantage plan with the choice of a PPO. You receive all the benefits of the Medicare Advantage plan and can choose from our complete network of doctors and facilities. If you prefer to see someone out of network, you may pay a bit more.

Can Anyone Enroll in a Medicare Advantage PPO?

If you are eligible for Medicare, you can choose a Medicare Advantage PPO. If you like the freedom to see specialists without a referral, you may want to choose a Medicare Advantage Plan that is a PPO. Also, if you don’t mind paying extra to see a doctor or health care provider who is out of network, a Medicare Advantage PPO might be a good fit.

What’s the Difference Between Medicare Advantage PPO Out-of-Network Providers and In-Network Providers?

Medicare Advantage PPO In-Network Providers

An Empire MediBlue PPO plan will have a list of providers you can choose from. These doctors, health care professionals, and other health care facilities have agreed to work with us. These are considered in-network providers. 

The providers in our network bill us directly for your care. When you see a network provider, you pay a lower share of the cost.

Medicare Advantage PPO Out-of-Network Providers

Other doctors and health care providers who have not agreed to work with us are considered out of network. When you choose an Empire MediBlue PPO plan you can choose to visit an out-of-network provider.

Your share of the cost for covered services may be higher when visiting a Medicare Advantage PPO out-of-network provider. You may pay additional deductibles, copays or coinsurance for services.

Other Types of Medicare Advantage Plans: HMOs and SNPs

The main difference between a Medicare Advantage PPO and a Medicare Advantage HMO is that with an HMO you can only see doctors or specialists who are in network. Also, when you want to see a specialist in an HMO, you must get a referral from your primary care physician (PCP), which you do not need in a PPO.

People with Medicare and Medicaid may enroll in a Medicare Advantage Special Needs Plan (SNP) plan. This plan specializes in the diseases of those enrolled. Members have access to a network of doctors specialized in their conditions and may receive other benefits such as home-delivered meals and transportation. 

What do MediBlue PPO Plans Cover?

Empire MediBlue PPO plans bring your medical and prescription coverage together in a convenient plan where you may select from our robust network of doctors and care providers or choose to see another out-of-network provider and pay more. All Empire MediBlue PPO plans include benefits similar to our Medicare Advantage HMO plans:

Many preventive services, such as regular check-ups, tests, shots and screenings, are included at no extra cost.
Original Medicare doesn’t cover prescriptions and medications that most people need. Most Medicare Advantage plans include Part D coverage.
Some Medicare Advantage Plans (Part C) may include vision and/or dental benefits that Medicare doesn’t cover. You may also add an optional supplemental benefit package for more coverage than what is included in a Medicare Advantage plan.
Some Medicare Advantage PPO plans cover routine hearing tests, hearing aid fittings, and hearing aids. Costs outside the network may be higher.
Some Medicare Advantage plans cover non-prescription over-the-counter (OTC) medicines and health-related items, such as pain relievers, cold medicine, and other first-aid care, at specific retailers.
As part of your Empire MediBlue PPO plan, you may also have access to SilverSneakers®, a popular fitness program for adults age 65+.
Star Ratings measure Medicare Advantage plans on a number of categories including customer service and quality of care. Medicare evaluates plans and assigns stars based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

We make it easy to find and compare the details of Empire MediBlue PPO plans available in your area.

What are the Costs of a Medicare Advantage PPO Plan?

Medicare Advantage plans can help you save money. Since you may decide to receive care in network or out of network with an Empire MediBlue PPO, some costs, such as deductibles, coinsurance or copays, may vary within the plan.

Typical Costs of an Empire MediBlue PPO

Monthly Costs

Monthly costs for Empire MediBlue PPO may be higher since you may make more choices about your care.

Deductibles

Some plans have $0 deductibles for medical costs. Your deductibles for out-of-network costs may be higher.

Copays or Coinsurance

The amount of copays or coinsurance you pay when you visit a doctor or specialist varies whether they are in network or out of network.

You’ll pay the lowest cost when visiting in-network providers, but have the option to pay a little more when you want to see an out-of-network provider.

Is a Medicare Advantage PPO Plan Right for Me?

Stethoscope

A Medicare Advantage PPO plan may be right for you if you agree with the following statements:

 
  • I want the freedom to choose doctors or facilities out-of-the network.
  • I would rather see a specialist on my own without getting a referral from a PCP.
  • My providers and facilities are participating in a number of different networks.
  • I don’t mind paying more sometimes if I want to see a doctor outside the network.
We have more information to help you understand the differences between Medicare Advantage PPOs and Medicare Advantage HMOs.

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Y0114_20_116987_U CMS Accepted 12/12/2019
505868MUMENMUB
 
Benefits, premiums, copays and plan may vary by county. Medicare Advantage plans may not be available in all counties.
 
The Medicare Advantage and Medicare Part D plans are health plans with a Medicare contract or a standalone prescription drug plan with a Medicare contract. The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.
 
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc. Empire BlueCross Retiree Solutions and/or Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc.  licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.  All external sites will open in a new browser window. Please view our website Privacy Policy for more information.
 
The SilverSneakers fitness program is provided by Tivity Health, an independent company. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2019 Tivity Health, Inc. All rights reserved.
 
For Dual-Eligible Special Needs Plans: This plan is available to anyone who has both Medical Assistance from the State and Medicare.
 
This information is not a complete description of benefits. Call Customer Service, (TTY:711) for more information.
 

Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call Customer Service, (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711). 注意:如果您使用非英語的其他語言,您可以免費獲得語言援助服務。請致電聯絡客戶服務部(聽語障用戶請致電:711)。