What Is a Medicare PPO Plan?

Updated: Nov 25, 2020

Medicare Advantage plans are private health insurance plans available to seniors who qualify for Medicare. These plans cover Parts A and B of Medicare insurance and typically also include prescription drug coverage and other services such as hearing and dental that Original Medicare does not cover. Medicare Preferred Provider Organization (PPO) Plans are one of four common kinds of Medicare Advantage plans. The other three common types are:

A Medicare agent at PBC can help you learn about whether a Medicare PPO plan is right for you. In this article we’re going to take an overall look at Medicare PPOs and how they work.

How Medicare PPOs work

PPOs have the same requirements as other Medicare Advantage plans; they must provide seniors with the same benefits, rights, and protections as Original Medicare. Most PPOs offer extra benefits, such as vision and hearing care but these services may cost extra.

PPO Plans have network health care providers and hospitals nationwide, making them a good option for kupuna who visit their family on the mainland or travel regularly (in normal times). Members do pay less if they seek care from in-network doctors and hospitals and pay more if they use doctors, hospitals, and providers outside of the network. Check with a Medicare Agent for individual plan details.

Can I join a Medicare PPO?

In order to qualify for a Medicare PPO Plan, you must already be enrolled in Medicare Parts A and B. In most cases, you will continue paying your Medicare Part B premium. Some PPOs charge an additional premium, on top of your Part B premium. One reason that a plan would charge an additional premium is if it includes prescription drug coverage and other additional services.

On a Medicare PPO do I have to get care within the PPO network?