2025 Elevance PPO Plans

A PPO is a plan in which enrollees pay less if they use doctors, hospitals, and providers that belong to the network. Services obtained from doctors, hospitals and providers outside the network will result in additional costs to the member – unless the services are classified as an emergency.

Enrollees do not need a referral to see a specialist or out-of-network provider, but they should verify the out-of-network provider will accept the patient for treatment.

The agent must confirm the provider’s network status for beneficiaries who are considering enrollment into the plan.

What extra benefits not covered by traditional Medicare MAY be provided by MA-PD plans?

“_____________care” is defined as a non-emergency situation when you need medical care right away because of an illness, injury or condition that you did not expect or anticipate, but your health is not in serious danger.

HMO and PPO plans have some basics in common, such as eligibility criteria and rules on rates.

PPO plans may or may not include Part D prescription coverage.

The Plan deductible always needs to be satisfied before preventive services are covered by the plan.

Which is NOT considered a preventive benefit?

Emergency care is always considered to be in network.