A Healthy CollaborationSM

Frequently Asked Questions

Any Questions about Today’s Options PPO?

Today’s Options PPO can help you get more out of your Medicare benefits. With low co-pays for network doctors and hospitals, and prescription drugs in some plans, it offers you the opportunity to save money on healthcare beyond the benefits of Original Medicare. And our caring community of health professionals is committed to helping you live healthier.

Q: What is a PPO (Preferred Provider Organization)?

A PPO is designed to reduce the cost of healthcare by contracting with certain doctors, labs, and hospitals to provide care at a discounted rate for its members. You will save the most when you utilize our comprehensive network of care providers, but a PPO will also pay a portion of your healthcare costs if you choose a doctor or hospital that isn’t in the network.

Q: With a PPO, is my choice of doctors limited?

No. You may go to any doctor, specialist, or hospital anywhere in the U.S., though you will enjoy optimum savings when you choose a provider within our local Today’s Options PPO network.

Q: Am I eligible for Today’s Options PPO?

You can join Today’s Options PPO if:

  • You have both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
  • You live in the plan’s service area.
  • You do not have End-Stage Renal Disease (permanent kidney failure treated by dialysis or a transplant, sometimes called ESRD).
  • If you do have ESRD and are currently an enrollee with a Medicare Advantage organization offering a PPO plan, you may join Today’s Options PPO.

If you have questions about your eligibility, ask a Today’s Options PPO representative for more information.

Q: How is a PPO different from an HMO?

PPOs and HMOs both offer members low costs on doctor visits, hospital stays and other services when they choose a network provider. The difference lies in the amount you pay out-of-pocket when using an out-of-network provider. You are responsible for 100 percent of the cost when choosing a provider that is not in your HMO network. With a PPO, your plan will still cover a percentage of the cost when you choose an out-of-network provider.

Q: Can I try a Today’s Options PPO without losing my Medicare Supplement?

Although you can keep your Medicare Supplement as long as you’d like, you’ll probably find that our plans cover the same benefits at a lower cost to you, so maintaining your Medicare Supplement at the same time you are covered by Today’s Options PPO may not be economical. If this is the first time you’ve joined a Medicare Advantage plan, you may have special protections that give you the right to get your old Medigap policy back if you choose to leave the plan within the first year. It’s best to check with a Today’s Options PPO representative to make sure you don’t miss out on important benefits.

Q: If I choose a Medicare Advantage plan with prescription drug coverage “powered by” CCRx, how will I know if the prescription medicines I currently take will be covered?

Our Medicare Advantage Prescription Drug plans have a formulary, or list of covered drugs. To learn if your medicines are covered, please contact a Today’s Options PPO representative at 1-866.724.3436 (TTY for the hearing impaired:1-800-958.2692) from 8 AM to 8 PM local time, 7 days a week. You can also see our formulary online at www.TodaysOptionsppo.com.

Q: What drugs are excluded from Medicare Advantage Prescription Drug Plans (MAPD)?

The drugs that are excluded by Medicare are:

  • Medications used to treat anorexia, weight loss, or weight gain
  • Medications used to promote fertility
  • Medications used for cosmetic purposes or hair growth
  • Medications used to treat erectile dysfunction
  • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparation
  • Non-prescription drugs

Outpatient medications for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale.

In addition, if a medication is covered by Medicare Parts A or B, it cannot be covered under Part D (Medicare Advantage Prescription Drug Plan). Some examples of Parts A or B medications include: diabetic test strips, injectables solely administered in the physician’s office and medications administered in the hospital. Also, each Medicare Advantage Prescription Drug plan may have its own specific exclusions.

Q: What if my prescription medicine is not on the formulary?

If your specific medicine is not on our formulary, there might be a similar, high-quality medicine available that offers the same benefits. For example, if you’re taking a cholesterol-lowering medicine, there might be a suitable alternative on our formulary. We’ll work with you and your doctor to find a covered medicine that best suits your condition.

Q: Does Today’s Options PPO have materials that are in Spanish?

Yes, Today’s Options PPO has Spanish materials available, such as the 2009 Summary of Benefits. You can request that Spanish materials be mailed to you by calling 1-866-724-3436 (TTY for the hearing impaired: 1-800-958-2692)8 AM to 8 PM in your local time zone, 7 days a week A Today’s Options PPO representative will be happy to help you.

M0018_TOPPO_209 Pending CMS Approval Last updated: 4/1/2022

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