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How Medicare Advantage PPO Plans Work
A Medicare PPO Plan is a type of Medicare Advantage Plan (Medicare Part C) offered by a private insurance company. PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.
What Is Medicare Prior Authorization?
Medicare uses Prior Authorization to ensure that certain medical services or prescription drugs meet specific coverage criteria before they are approved and paid for. Prior Authorization rules are implemented as cost-saving measures. Medicare wants to ensure that every Medical Procedure is medically necessary for the beneficiary's health.
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