There seems to be much confusion around the Medicare Advantage PPO Plans, all but one of which are no longer offered in Riverside County for 2026. There are some Advantage PPO plans available in other counties. However, companies offering Advantage PPO plans in Riverside County determined those plans were no longer sustainable and sent notices to members that their plan would no longer be offered in 2026.
If a PPO member desires to keep all their doctors who may not participate in an Advantage HMO Plan, an alternative is a Medicare Supplement, also known as a Medigap plan. The letter giving notice that their Advantage PPO plan was ending, allows them to apply for a Medigap Plan with guaranteed approval, within two months of the end date of their Plan.
These Medigap plans are different than the PPO and HMO Advantage Plans, because there is no “Network”. In other words, on a Medigap plan, you use your Medicare card and can see any doctor who accepts Medicare. Medicare pays the doctors directly, and the Medigap plan supplements those payments according to the plan’s benefits.
With Advantage Plans, Medicare does not pay the doctors. Instead, Medicare pays the Plan, and the Plan pays the doctors who are contracted with the Plan – “in network”. People often mistakenly call their Medigap plan a PPO, which often creates confusion at a doctor’s office. When on a Medicare Supplement, the key question to ask at the doctor’s office is if they accept Medicare. If they accept Medicare, then the Medigap payment will follow Medicare’s payment to that doctor. There is no need to check a network as there is in Medicare Advantage PPO and HMO Plans, and no referrals are necessary.
Visit HealthBridgeInsurance.com for more information.
For expert advice, contact Marv Law at HealthBridge Insurance Solutions by phone at 760-345-4705, or email [email protected]
