What Is a Medicare PPO Plan?
Preferred Provider Organization (PPO) Plans are a type of Medicare Advantage (Part C) plan that offers flexibility in how and where you receive care. PPOs allow you to see any doctor or specialist—in or out of the network—without needing a referral.
You’ll typically pay less when using providers within your plan’s network, but you’re not restricted to network providers, making PPOs ideal for those who want more provider choice.
Key Benefits of PPO Plans
More Freedom to Choose Providers
- You can see out-of-network providers, though at a higher cost
No referrals needed to see specialists
All-in-One Coverage
Covers Medicare Part A (hospital) and Part B (medical) services
Most PPOs also include Medicare Part D (prescription drug coverage)
Frequently includes dental, vision, hearing, wellness, and telehealth benefits
Emergency and Urgent Care Nationwide
All PPO plans cover emergency and urgent care regardless of provider network
What’s the Cost of a PPO Plan?
PPO plans typically come with:
Monthly premiums, which vary by insurer and location
Part B premium, which you continue to pay
Copayments and coinsurance, especially for out-of-network services
An annual out-of-pocket maximum to help protect you from excessive costs
Costs vary depending on where you live and the plan provider. Some PPO plans have $0 premiums, while others may charge more for added benefits or broad provider networks.
Medigap and Medicare PPOs
If you join a Medicare Advantage PPO Plan, any Medigap (Medicare Supplement) policy you have will no longer coordinate with your plan. While you are legally allowed to keep your Medigap plan, it won’t help cover copayments or deductibles under your Medicare Advantage plan.
For this reason, most people drop Medigap coverage when enrolling in a PPO or other Medicare Advantage plan.
Who Should Consider a PPO Plan?
You might benefit from a Medicare Advantage PPO if you:
Travel often or live in multiple locations during the year
Want access to a broader range of doctors and hospitals
Prefer not to get referrals for specialist visits
Are okay with potentially higher out-of-pocket costs for flexibility
Plan Availability and Support
Medicare Advantage PPO plans are offered regionally, and availability varies by county and zip code. Premiums, coverage features, and provider networks can change annually.
At MedicareMall, we help you:
Compare available PPO plans in your area
Review drug formularies and provider lists
Understand coverage exclusions and cost structures
Enroll quickly and confidently with support from licensed experts