What is a PPO Medicare Advantage Health Plan? (2024)

A Preferred Provider Organization (PPO) plan gives you a financial incentive to choose doctors and health care facilities within the network. You can use out-of-network providers for Medicare-covered services, but you’ll pay more.

These plans may also offer additional benefits beyond Medicare Parts A and B. For instance, some Advantage plans cover dental and vision care.

What is a PPO plan?

A PPO (Preferred Provider Organization) plan is a type of Medicare Advantage health plan. These plans offer more provider flexibility than HMOs do and are a popular choice for people who want more freedom in their medical providers.

These plans have a list of preferred doctors, hospitals, and other health care professionals. If you choose to use one of these providers, you can pay a lower copay or deductible.

The cost of these plans can vary based on where you live and what benefits you get. Some have low, fixed copays for doctor visits and outpatient lab tests.

Unlike an HMO, a Medicare Advantage PPO doesn’t require you to pick a primary care physician or get referrals from your doctor for specialists. This makes them a good option for people who value flexibility in their provider choices and who may not have access to a high-quality doctor who can coordinate their care.

How does a PPO plan work?

A PPO, or participating provider organization plan, gives you more flexibility than a health insurance plan like an HMO. You can use any doctor or hospital you like — even outside your plan’s network. However, this can cost you more out-of-pocket than with an HMO, and you may have to meet a deductible before your insurance covers any services.

Choosing a plan can depend on many factors, including the type of medical needs your family has and your budget. But the freedom of a PPO might be worth it for you and your family.

Not need specialist referrals: If you have a primary care doctor (PCP) or want to see a specialist regularly, a PPO might be the right choice for you. These plans don’t require referrals from your PCP and won’t cover any costs if you use a doctor or hospital that’s not in your network.

Deductibles: These are the costs you’ll pay out-of-pocket each year before your Medicare Advantage health insurance takes over and covers the rest of your care.

How much does a PPO plan cost?

PPO plans, or preferred provider organizations, have a group of healthcare providers and hospitals that offer lower costs than using out-of-network doctors and facilities. These providers agree to provide care at a fixed rate for the plan members.

However, in some cases, you may need to pay higher copayments and deductibles for your medical visits with health care providers who aren't in the plan's network. These costs are called out-of-network expenses.

Deductible: An annual amount that you must spend before the insurance company starts paying. It can go up from year to year, but it's set by the insurance agreement.

The average premium for a Medicare Advantage PPO plan is $18 per month in 2022. That's much lower than the average Medicare Part D premium of $40 per month in 2022, according to the Kaiser Family Foundation (KFF).

How do I get a PPO plan?

A PPO plan is a type of health insurance that lets you choose which doctors, hospitals and other medical service providers to use for your care. It typically has higher monthly premiums and out-of-pocket costs than a HMO plan, but can be more affordable if you stay within the network.

If you are looking for a Medicare plan that offers more flexibility than an HMO, a PPO might be the best option. With a PPO, you can visit any doctor and hospital without a referral, including specialists.

You can also save money by seeing a specialist in the network instead of going outside it. However, it is important to note that out-of-network costs can add up quickly.

In addition, some PPO plans require you to meet a deductible before coverage starts. This deductible is a fixed amount you must pay before your health insurance starts covering your medical expenses.

What is a PPO Medicare Advantage Health Plan? (2024)
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