Medicare Advantage PPO Plans

Is a Medicare Advantage PPO plan right for you?

Preferred Provider Organizations (PPOs) are a type of Medicare Advantage plan that the federal government pays to administer Medicare benefits. As is required with all Medicare Advantage plans, they must provide you with the same or better coverage than Original Medicare (Parts A and B).

In a PPO Medicare Advantage plan, you have more flexibility, with coverage for both in-network and out-of-network providers. You will usually pay less when you visit an in-network doctor, hospital, or other provider.
With some plans, out-of-network services can also have a higher maximum out-of-pocket cost.

If you are wondering if a Medicare Advantage PPO plan is the right choice for you, or if you have specific questions about what the advantages are, we would love to help.

Do I have to pick a primary care doctor with a PPO Medicare Advantage plan?

Most PPO plans will not require the selection of a Primary Care Physician (PCP) when you apply.

Do PPO Medicare Advantage plans require referrals to see a specialist?

In most cases, referrals are not required to see a specialist in a PPO plan. It will generally be less expensive to see an in-network specialist than an out-of-network specialist.

Does a PPO Medicare Advantage plan cover prescription drugs?

  • Most Medicare Advantage PPO plans are MAPD plans, which do cover prescription drugs. You will need to consult the plans Summary of Benefits to determine if prescription drugs are covered.
  • Plans designed for Veterans do not normally cover prescriptions drugs, as to not conflict with Veteran’s benefits.

What happens if I see an out-of-network doctor when I am on a PPO Medicare Advantage plan?

In most cases, you will have coverage for out-of-network services on a PPO Medicare Advantage plan. However, you may have higher out-of-pocket costs, as compared to in-network services.

Can I have a PPO Medicare Advantage plan with a separate prescription drug plan?

In most cases, no. The majority of PPO Medicare Advantage plans will have prescription drug coverage included. If you enroll in a separate Prescription Drug Plan (PDP), you will be disenrolled from your Medicare Advantage plan.