Preferred Provider Organization (PPO)

Medicare Advantage Preferred Provider Organization (PPO) Plans offer coordinated care from a network of chosen providers. It is a great option for those seeking consistent coverage at a reasonable price.

How Do PPO Plans Work?

Medicare PPO plans offer a fuller-coverage alternative to Original Medicare. By curating a network of healthcare providers, PPO plans coordinate coverage and reduce your overall costs. Within this network, you will be faced with less out-of-pocket costs.

If you do seek out-of-network care, there is a cap on your expenses. You will, then, be safe in case of expensive emergency outpatient care. This plan, then, offers more flexibility than other Medicare Advantage plans.

Cost

As with all Medicare Advantage plans, you will still have to pay your Medicare Part B premium. Your Medicare Part B premium is required no matter the Advantage plan you choose. The standard part B premium for 2020 is $144.60 (this is subject to change).

PPO-specific charges include monthly premiums, a yearly deductible, and certain copayments depending on the status of the healthcare provider. For instance, in-network doctors will cost less than those out-of-network.

Coverage and Benefits

Compared to other Medicare Advantage plans, PPO plans offer more flexible coverage. PPO plans:

Allow for doctors in more cities and states than other Medicare plans
Do not referrals needed for specialist care
Do not require primary care doctors
Cover prescription drugs (in most cases)

PPOs vs. HMOs

Both HMO and PPO plans are privately-offered alternatives to Original Medicare, both offering the same coverage as Plans A and B as well as additional benefits, including most prescription drug costs. They both also rely on a curated network of healthcare providers.

The difference between these plans involves their management of their respective network. PPO plans will charge less for in-network care while still offering minimal coverage for out-of-network care.

HMO plans, on the other hand, do not cover out-of-network providers, choosing instead to focus on a specific zone. This greatly reduces charges by only covering costs as-needed. Both plans, then, have distinct benefits, and it is up to you to decide which will work best for your medical needs.

HMOs

Out of Network Coverage

State Or Nationwide

Provider Network

No Referrals To See Specialist

Easy To Use

Both

Dental

Vision

Hearing

Prescriptions

Affordable

PPOs

Low or No Premiums

Lower Out of Pocket Cost

Lower Copayments

Smaller Network

Does Not Cover Out of Network

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