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 toproviders and facilities that are belong tothe plan's network.
- You can generally go toout‑of‑network providers for covered services, but you’ll usually pay more.
Questions you may have about PPOs:
| Question: | Answer: |
|---|---|
| Do these plans charge a monthly premium? | 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. PPOs & drug coverage If you want prescription drug coverage, you have to join a PPO that offers it. If you join aPPO that doesn’t offer drug coverage, you can’t join a separate Medicare drug plan. |
| 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? | No. |
| Do I have to get a referral to see a specialist? | No. |
| What else do I need to know? |
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