Preferred Provider Organizations

Preferred Provider Organization (PPO)

A Preferred Provider Organization (PPO) is a type of Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Can clients get their health care from any doctor, other health care provider, or hospital?

  • In most cases, they can get their health care from any doctor, other health care provider, or hospital in PPO Plans. PPO Plans have network doctors, other health care providers, and hospitals. Each plan gives them flexibility to go to doctors, specialists, or hospitals that aren’t on the plan’s list, but it will usually cost more

Are prescription drugs covered?

  • In most cases, prescription drugs are covered in PPO Plans. If your client wants Medicare drug coverage, they must join a PPO Plan that offers prescription drug coverage. Remember, if they join a PPO Plan that doesn’t offer prescription drug coverage, they can’t join a Medicare Prescription Drug Plan (Part D).

Do clients need to choose a primary care doctor?

  • They don’t need to choose a primary care doctor in PPO Plans.

Do clients have to get a referral to see a specialist?

  • In most cases, they don’t have to get a referral to see a specialist in PPO Plans. If they use plan specialists, their costs for covered services will usually be lower than if they use non-plan specialists.

What else do clients need to know about this type of plan?