Jack's Blog on Medicare Plan Choices

First the basics: PPO Plans are health insurance plans that work with a network of doctors, hospitals, and other healthcare providers. This network is a list of all the medical professionals and places that the insurance plan has made agreements with to provide care to you, their customer.  One big lesson I learned in my many years in the medical field.  It’s all about contracts.  Networks and contracts go hand in hand.  You may find that insurance carriers like contracts to last at least three years and hospitals like shorted contracts.  Nobody wants the short end of the stick. 

So, two key things to remember:

• PPO plans work with a network of pre-approved providers
• Seeing providers in the network usually costs less than going outside the network

LPPO vs. RPPO.

The key distinction between LPPO and RPPO plans lies in their coverage areas. An LPPO plan provides in-network coverage within a localized geographic region, while an RPPO plan offers in-network coverage over a wider, regional service area.

Depending on your healthcare needs and the providers you prefer to use, the difference between an LPPO and RPPO plan could have a significant financial impact. It’s important to carefully evaluate the coverage areas, in-network providers, premiums, deductibles, and other plan details. Taking the time to understand these distinctions can help you maximize your healthcare dollars and access the care you need.

Medicare is divided into specific geographic regions for the purposes of administering certain Medicare Advantage and Medicare Part D plans. These geographic regions are known as Medicare regions or service areas.

So, to break it down, an RPPO plan encompasses a larger area and gives you access to more doctors and hospitals.  The LPPO plans encompass a smaller footprint.  That smaller footprint MAY serve you needs in most cases.  Most carriers will give you a better monthly premium with the LPPO plan.  In face you might see an LPPO plan with a $0 premium right next to a RPPO plan with a premium in the high $40 range. 

In addition to a lower premium, a LPPO plan may give you much better “beyond Medicare” benefits to save you hundreds of dollars a year.  When I say, “beyond Medicare,” I’m talking about things such as:

·  Dental care

·  Vision care

·  Hearing aids and exams

·  Fitness programs or gym memberships

·  Over-the-counter medication allowances

·  Transportation to medical appointments

·  Meal delivery services

You might think that it would be easy to identify all the Medicare regions through the Medicare.gov website.  Sorry to tell you that I found it very difficult. I also searched CMS.gov, as well as two different AI engines.  As best as I can tell, here are the RPPO regions:

1. Region 1: ME, NH, VT, MA, RI, CT
2. Region 2: NY
3. Region 3: PA, WV
4. Region 4: OH
5. Region 5: IN, MI
6. Region 6: IL, WI
7. Region 7: MO, KS
8. Region 8: MN, IA, MT, ND, SD, WY, NE
9. Region 9: FL
10. Region 10: GA, NC, SC
11. Region 11: AL, TN
12. Region 12: KY, OH
13. Region 13: MI
14. Region 14: TX
15. Region 15: AR, LA, MS
16. Region 16: CO, NM
17. Region 17: AZ, NV, UT
18. Region 18: ID, OR, WA
19. Region 19: CA
20. Region 20: AK, HI
21. Region 21: ID, OR
22. Region 22: NV
23. Region 23: OK
24. Region 24: NM
25. Region 25: VA, DC, MD, DE

Because the insurance carriers have a larger financial burden with the larger footprint of the Medicare regions, those plans cost you more while providing less benefits.  So, check to see if a LPPO plan covers the providers that you want to use.