What Are Your Options with a PPO (Preferred Provider Organization) Health Plan?
Explore PPO Coverage Options and Find the Right Fit for Your Healthcare Needs
Understanding Medicare Advantage PPO Plans
How PPO Plans Work
With a PPO plan:
- Emergency care and urgent care are always covered, even out of network
- You are encouraged to use in-network providers for the lowest costs
- You can see providers outside the network, but it may cost more
- You do not need to select a primary care doctor
- You do not need referrals to see a specialist
Costs in a PPO Plan
Costs can vary based on the plan and how you use it. You may have:
- A monthly premium (some plans have $0 premiums)
- An annual deductible you must pay before coverage begins
- Co-payments or co-insurance for services like doctor visits or lab tests
- A yearly limit on out-of-pocket costs
- Higher costs when using out-of-network providers
- Reviewing a plan’s cost structure helps you avoid unexpected bills.
Is a PPO Plan Right for You?
A PPO plan may be a good option if you:
- Are okay with paying a bit more for extra provider choices
- Want to see doctors and specialists without referrals
- Travel often or live in more than one location
- Want flexibility to get care outside the plan’s network
What to Review Before Choosing a Plan
When looking at PPO plan options, consider the following:
- Are your current doctors and hospitals in the plan’s network?
- Does the plan cover the prescription drugs you need?
- What will your monthly premium, deductible, and co-pays be?
- What is the maximum out-of-pocket limit for the year?
- What services are included as extra benefits?
When are you eligible for a Medicare Advantage plan?
- If you’re 65 or older
- If you have other Medicare coverage, you can change to Medicare Advantage during annual open enrollment
- You may also qualify under other exceptions, such as an eligible disability or chronic condition
Understanding Medicare Advantage PPO Plans
How PPO Plans Work
With a PPO plan:
- Emergency care and urgent care are always covered, even out of network
- You are encouraged to use in-network providers for the lowest costs
- You can see providers outside the network, but it may cost more
- You do not need to select a primary care doctor
- You do not need referrals to see a specialist
Costs in a PPO Plan
Costs can vary based on the plan and how you use it. You may have:
- A monthly premium (some plans have $0 premiums)
- An annual deductible you must pay before coverage begins
- Co-payments or co-insurance for services like doctor visits or lab tests
- A yearly limit on out-of-pocket costs
- Higher costs when using out-of-network providers
- Reviewing a plan’s cost structure helps you avoid unexpected bills.
Is a PPO Plan Right for You?
A PPO plan may be a good option if you:
- Are okay with paying a bit more for extra provider choices
- Want to see doctors and specialists without referrals
- Travel often or live in more than one location
- Want flexibility to get care outside the plan’s network
What to Review Before Choosing a Plan
When looking at PPO plan options, consider the following:
- Are your current doctors and hospitals in the plan’s network?
- Does the plan cover the prescription drugs you need?
- What will your monthly premium, deductible, and co-pays be?
- What is the maximum out-of-pocket limit for the year?
- What services are included as extra benefits?
When are you eligible for a Medicare Advantage plan?
- If you’re 65 or older
- If you have other Medicare coverage, you can change to Medicare Advantage during annual open enrollment
- You may also qualify under other exceptions, such as an eligible disability or chronic condition
