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HMO or PPO or Senior Supplement -- What's the difference?

Senior Supplement vs. PPO

The ASRS has always offered group-rate plans for ASRS retirees, including those on Medicare. The marketplace is flooded with offerings for insurance options that help pay that last 20% of retiree medical bills -- as well as all the prescription drug costs -- after Medicare covers the first 80%.

In years past, the ASRS has offered a nationwide Senior Supplement plan for those who travel and/or prefer the freedom to see any doctor who accepts Medicare, as well as a Medicare Advantage HMO plan for in-state retirees who don't travel as much and prefer the lower cost in premiums. Prescription drug coverage was offered through the UnitedHealthcare® MedicareRx℠ for Groups PDP plan.

This year, the ASRS is replacing the UnitedHealthcare® Senior Supplement plan with a UnitedHealthcare® Group Medicare Advantage PPO plan offering.

The PPO plan offers access to any willing Medicare provider nationwide

Any doctor willing to accept Medicare at all (Such as Senior Supplement) should accept your ASRS Medicare Advantage PPO card. Now it's even easier. Now you only need the ONE CARD to present to your doctor or provider. UnitedHealthcare will pay the claim, and then be reimbursed by Medicare later.

Same as the Senior Supplement, the UnitedHealthcare Group Medicare Advantage PPO network provides for a national service area that includes all U.S. counties, District of Columbia and all U.S. territories. The plan travels with you and allows access throughout the United States without referrals.

The PPO plan has same benefits and copays as Senior Supplement

All the benefits and copays are the same on the Group Medicare Advantage PPO as they were on the Senior Supplement.

The PPO plan has 98.4% the same drug coverage as Senior Supplement

Prescription drug coverage copays are the same on the Group Medicare Advantage PPO plan. See the Guide for more details. Special note: for retirees converting to the new Group Medicare Advantage PPO: some medications (less than 2% of prescriptions) are considered to be “High Risk Medications". Prior authorizations may be required to continue to utilize these medications once coverage is moved to the Group Medicare Advantage PPO. Additional formulary alternatives are also available.

The PPO plan offers lower premiums and more care management

Because of the way a Medicare Advantage PPO plan works, as well as thanks to the Retrospective Rate Agreement funding, the premium you'll pay for the nationwide PPO plan is less than half what retirees paid for the Senior Supplement at any point in the last 10 years.

The new Group Medicare Advantage PPO plan offers a number of new care management services not previously offered to retirees who enrolled in Senior Supplement, including access to Virtual Visits, HouseCalls, routine podiatry and hearing exams as well as better foreign travel and hearing aid benefits. Read the Enrollment Guide for more details on these programs.

HMO vs. PPO

The ASRS now offers two kinds types(?) of Medicare Advantage plans, both HMO and PPO, to ASRS retirees. Like many ASRS members, you may have heard conversations about which plan may or may not be better. All the opinions and information lead us to the same basic question: As an ASRS Retiree, how do I decide between an HMO and a PPO health benefits plan, and how do I find out which of these plan types is designed to best meet my health care needs?

The ASRS cannot tell you which plan is better for you, but we can highlight the two biggest diffrences between the HMO and PPO.

Different provider networks

The HMO plan has several networks that you may choose from where you will need to designate your Primary Care Physician and get all services via referrals within the network, with the exception of emergencies. Retirees must live and receive services within the state of Arizona within the network available in the county they reside.

With a HMO, there is always the possibility of a provider leaving the HMO network which means you would need to select a new provider.

The PPO plan is nationwide and only requires that the provider is willing to accept Medicare and the plan. The provider does not have to be in the UnitedHealthcare network and you will pay the same share of the costs where you see a provider who is in or out of the network.

Different drug coverage "in the gap"

The HMO plan covers more of your drug costs "in the gap" than the PPO covers. See the table on this page, and review your Guide carefully.

Other small differences

There are some other small differences between the HMO and PPO in terms of copays, coinsurance and benefit coverages. See your Medicare Guide for detailed side-by-side comparisons of the two plans.

2019 Medicare Insurance Plans

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