Select the option that accurately represents Medicare Advantage (MA) Plan Network characteristics for non-emergency care.

• A. HMO plans allow out-of-network benefits at lower cost.
• B. PPO plans prohibit out-of-network services.
• C. PPO plan members can use out-of-network benefits, generally at a higher cost.
• D. All MA plans have identical networks and costs.

Answer: (C)

Medicare Advantage plan networks shape how you access care and what you pay when the visit isn’t an emergency. In a PPO-type MA plan, you have the option to use providers outside the plan’s network for non-emergency care, and doing so generally comes with higher cost-sharing. You still get covered services, but your out-of-pocket costs rise because out-of-network providers aren’t contracted with the plan at the discounted rates you get in-network. This flexibility contrasts with many MA offerings like HMOs, where staying in-network is usually required for non-emergency services, and out-of-network options are limited or not covered. Since MA plans vary by plan and region, costs and network rules aren’t identical across all plans. The idea that PPOs allow out-of-network care with higher costs is the best representation of MA plan network characteristics for non-emergency care.