Preferred Provider Organizations (PPOs)
What's a PPO?
A PPO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PPOs have networks of doctors, other health care providers, and hospitals.
- You pay less if you go to providers and facilities that are belong to the plan's network .
- You can generally go to out‑of‑network providers for covered services, but you’ll usually pay more.
Questions you may have about PPOs:
|Do these plans charge a monthly
|Yes. These plans usually charge a premium, in addition to the monthly Part B (Medical Insurance) premium.|
|Do these plans offer Medicare drug coverage (Part D) ?||
Usually. Prescription drugs are covered in most PPO Plans. Check with the plan you’re interested in.
|Can I use any doctor or hospital that accepts Medicare for covered services?||
Yes. You can also use out-of-network providers for covered services, if they’re participating in Medicare or accept assignment , but you'll usually pay more.
Before you get services from an out-of-network provider, contact your PPO Plan to ensure the services are medically necessary and covered by your plan. You’re always covered for emergency and urgent care.
|Do I need to choose a
primary care doctor ?
|Do I have to get a referral to see a specialist?||No.|
|What else do I need to know?||