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PPO | Preferred Provider Organization

What is a PPO plan?

Medicare Advantage PPO (Preferred Provider Organization) Plans

Important Facts About Medicare PPO Plans:
PPO–Drug Benefits

Prescription Drug Benefits

PPO plans usually offer Medicare Part D prescription drug benefits. Part D is Medicare’s prescription drug benefit.

PPO–Network Providers

PPO Network Providers

If you are enrolled in a PPO MA plan, and you wish to have Medicare drug coverage you must get it from that plan. Some PPO’s offer additional benefits such as dental and vision care, but those may come at an extra cost. In order to have the lowest costs with your PPO plan you must use providers within the PPO’s network unless you find yourself in urgent care or an emergency situation.

PPO–Out of Network Providers

Out-of-Network Services

PPOs must cover out-of-network services, but you may be required to pay more if you go outside the plan’s network. Some find that another benefit to a PPO is that you are able to see a specialist without a referral from your Primary Care Physician.
PPO–Cost Limits

PPO Cost Limits

PPOs are limited in how much they can charge you for copays, however for some kinds of care they can and may charge more than Original Medicare. This care includes home care and care in skilled nursing facilities. Plans must have an annual out-of-pocket limit on how much you pay, but PPOs have two different out-of-pocket limits, one for in-network care and one for out-of-network care. These limits may be high, but they can protect you from excessive costs if you need extra care or expensive treatments.

PPO–Plan Premiums

Plan Premiums

If you enroll in a MA plan you will still be required to pay your monthly Part B premium of $135.50, which is the premium amount for 2019. You will also be required to pay your plan’s premium, if any, that is required by the plan. There are some MA plans with $0 premiums, but please note that even if your MA plan premium is $0 you will still be required to pay your Part B premium. 

PPO–Plan Responsibilities

PPO Plan Responsibilities

You will also be responsible for any deductibles, coinsurance, or copayments associated with the Medicare Advantage PPO plan you select.

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