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What is a Preferred Provider Organization (PPO) Medicare Advantage Plan?

By Ashley Hinson
Discovering how PPO plans work could help you select the right Medicare Advantage plan.

Medicare Advantage plans are available in a variety of standardized forms. A Preferred Provider Organization (PPO) Medicare Advantage plan gives you access to a network of doctors, hospitals, and healthcare providers, but how does staying in the network save you money? Read on for important details, drawn directly from the official U.S. government website for Medicare, to see if a PPO plan might be right for you. 

Medicare Advantage PPO Plans

A Medicare Advantage plan, or Medicare Part C, is an alternative to coverage with Original Medicare (Parts A and B). Advantage plans are offered by private insurance companies who must follow Medicare’s rules. There are different types of Medicare Advantage plans, including:

  • Preferred Provider Organization (PPO) Plans
  • Health Maintenance Organization (HMO) Plans  
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

So how do PPO plans work? PPOs are managed care insurance plans that give you access to a select network of healthcare providers with discounted rates for plan members. This means that getting routine check-ups, annual appointments, and even hospital visits will cost less than going out of your network with another provider. 

At a glance, PPO plans:

  • Have a relatively smaller network of healthcare providers
  • Offer lower costs for in-network services
  • Do not route care through a primary care physician

Unlike many HMOs, PPOs do not require you to choose a primary care physician, and you won’t need a referral to receive care from a specialist or a provider out of your plan’s network. 

With a PPO plan, you can see healthcare providers outside of your network for services PPOs cover. However, going out of your plan's preferred network of hospitals, doctors, and specialists will usually cost more. Additionally, emergency and urgent care are always covered under Medicare Advantage plans. 

Drug coverage, or Medicare Part D, is often included in Medicare Advantage plans like PPOs. You won’t need to sign up for a separate Medicare plan for your prescriptions as long as your PPO plan offers drug coverage. However, if you sign up for a Medicare Advantage PPO plan that doesn't have drug coverage, you can’t sign up for a separate Medicare drug plan. 

    Medicare Advantage PPO plans come in a variety of forms, and the private insurers offering them will vary by region. You can use the official U.S. government website for Medicare to check and compare the Medicare Advantage programs available to you. 

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    Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.