A Medicare PPO Plan is a Medicare Advantage Plan offered by a private insurance company. Medicare pays a set amount of money every month to the private insurance company to provide health care to people with Medicare. A Medicare PPO Plan has a list (called a “network”) of primary care doctors, specialists, and hospitals that you may go to. You can go to any doctor, specialist, or hospital not on the plan’s list, but it will usually cost more.
Some Medicare PPO Plans offer prescription drug coverage. Some plans also offer additional benefits, such as vision and hearing screenings, disease management, and other services not covered under the Original Medicare Plan. Monthly premiums and how much you pay for services vary depending on the plan.
There are two types of Medicare PPO Plans:
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Regional Preferred Provider Organizations Plans—these plans serve one of 26 regions decided by Medicare (these may be a single state or multi-state area)
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Local Preferred Provider Organizations Plans—these plans serve the counties the PPO Plan chooses to include in its service area
Regional PPO Plans have an added protection for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. There is an annual limit on your out-of-pocket costs. This limit varies depending on the plan.
Note: You can get your Medicare prescription drug coverage from your Medicare PPO Plan if your plan offers prescription drug coverage. Insurance companies offering a Medicare PPO Plan are required to offer a plan that includes Medicare prescription drug coverage. If you join a Medicare PPO Plan that doesn’t include such coverage, you can’t join a Medicare Prescription Drug Plan.
