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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
 Medicare PPO and HMO Comparison Chart
For more information, refer to the REHP Handbook or contact PEBTF.
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