Preferred Provider Organization (PPO)
How PPO Plans Work
A Medicare PPO plan is a type of
Medicare Advantage Plan (Part C)
offered by a private insurance company. PPO plans have doctors, other health providers, and hospitals that belong to a network. You will pay less if you use doctors, hospitals, and other health providers that belong to the
net. You can also use out-of-network providers for
covered services, usually at a higher cost, if the provider has
agreed to treat you and has not opted out of Medicare (for Medicare Part A and Part B items and services
). You will always have coverage for emergencies and urgent health care.
Can health services be obtained from any doctor, health provider, or hospital?
In most cases, you can get care from any doctor, other
health care provider
, or hospital in PPO plans. Each plan gives you the flexibility to visit doctors, specialists, or hospitals that aren’t on the plan’s list, but they usually cost more.
Are prescription drugs covered?
In most cases, PPO plans cover prescription drugs. Ask to plan. If you want Medicare drug coverage, you must join a PPO Plan that offers prescription drug coverage. Remember, if you join a PPO plan that doesn’t offer prescription drug coverage, you can’t join the
Medicare Prescription Drug Plan (Part D)
Should a Primary Health Care Physician be chosen?
You do not need to choose a primary care physician in PPO plans.
Do I need a referral to see a specialist?
In most cases, no. But if you use plan (in-network) specialists, your costs for covered services will generally be less than if you use non-plan (out-of-network) specialists.
What else do you need to know about this type of plan?
- Because certain providers are “preferred,” you can save money by using them.
- Contact the plan for more information.