How Preferred Provider Organization (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 network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
In most cases, you can get your health care from any doctor, other health care provider, or hospital in Preferred Provider Organization (PPO)Plans. Each plan gives you the flexibility to go to doctors, specialists, or hospitals that aren’t on the plan’s list, but it will usually cost more.
In most cases, prescription drugs are covered in PPO Plans. Ask the 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 a Medicare Prescription Drug Plan (Part D).
You don’t need to choose a primary care doctor in PPO Plans.
In most cases, you don’t have to get a referral to see a specialist in PPO Plans. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists. Benefits you are eligible for will depend on your area and plan providers.