What is an RPPO medicare complete choice plan?

A fellow caregiver asked...

What is an RPPO medicare complete choice plan?

Expert Answer

Medicare RPPO stands for Regional Preferred Provider Organization. A preferred provider organization is one of the several different ways you can participate in Medicare. The several parts of Medicare include:
• Original Medicare Part A  and Medicare Part B, which provide coverage for hospital and skilled nursing facility care (Part A) and doctors and outpatient care (Part B);
Medicare Part C Medicare Advantage plans, which replace Medicare Part A and Medicare Part B, providing the coverage offered by Part A and Part B as well as additional services, but placing limits on how or from whom you can receive those services; and
Medicare Part D, a separate program in which insurance policies provide prescription drug coverage.

One type of Medicare Part C Medicare Advantage plan is a preferred provider organization (PPO). A PPO is a combination type of plan that offers the cost savings of a health maintenance organization (HMO) with a wider choice of doctors and other providers than an actual HMO does. A PPO maintains a network of doctors and other providers (referred to as the "preferred providers"), the same as an HMO does; if you receive your medical care from a preferred provider, your out-of-pocket costs are less. However, a PPO also allows you to get services from doctors or other providers who are not in the "preferred" network; if you do, however, you pay higher out-of-pocket costs.

The "Regional" part of an RPPO simply means that the network of preferred providers is not limited to one state only but crosses state boundaries within a specified region.

The term "complete" might refer to the inclusion of prescription drug coverage within the plan (making it unnecessary to enroll in a separate Medicare Part D prescription drug program). But "complete choice" is a marketing phrase, not a technical Medicare term, and it may just suggest complete coverage without having have any specific meaning.

As with all Medicare Advantage plans, the devil is in the details. That means that before enrolling in any plan, you must get the details of costs and coverage from the plan itself, and compare it with other types of coverage that are available to you.