1. Type of mixed health-plan model that combines managed care and traditional insurance. Enrollees receive the highest level of benefits when they obtain services from a physician, hospital, or other health provider designated by their program as a “preferred provider.” They may receive substantial, though reduced, benefits or may have additional cost when they obtain care from a provider of their own choosing who is not designated as a “preferred provider” by their program. 2. A Medicare+Choice coordinated care plan that has a network of providers who have agreed to a contractually specified reimbursement for covered benefits with the organization offering the plan. It provides for payment for all covered benefits regardless of whether the benefits are given with the network of providers. It is offered by an organization that is not licensed or organized under state law as a health maintenance organization (HMO). 3. Type of Medicare Advantage Plan in which the patient uses doctors, hospitals, and providers that belong to the network. Patients can use doctors, hospitals, and providers outside of the network for an additional cost.
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An organization of health care providers and/or facilities that offers a discount on services to members of the PPO.