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Retired Members Information: Medicare PPO

Summary

  • MPPO offers both an in-network and an out-of-network benefit
  • In order to receive the highest level of benefits, you must choose one of the in-network physicians or facilities
  • You may self refer for medically necessary care. There is no need to have your care coordinated by a Primary Care Physician (PCP)

In-Network Services:

  • Annual in-network deductible is equal to the annual Medicare Part B deductible
  • $20 copayment for PCP office visit (In Network)
  • $30 copayment for specialist office visit (In Network)
  • $100 copayment for emergency room visit (waived if the visit leads to an inpatient admission to the hospital)

Out-of-Network Services:

  • Annual out-of-network deductible is equal to two times the annual Medicare Part B deductible
  • Out of network benefit – 80% plan payment; member pays 20% after deductible

PDFMedicare PPO and HMO Comparison Chart

For more information, refer to the REHP Handbook or contact PEBTF.

Aetna MedicareSM Plan (PPO) www.aetnamedicare.com
Provider Directory: www.aetnamedicare.com/ (select plan "Aetna MedicareSM Plan (PPO)")