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.

A PPO has a more flexible or open network of doctors and hospitals than an HMO or an HMO-POS (Point of Service).

If I join an PPO...

Can I get my health care from any doctor, other health care provider, or hospital?

In most cases, yes.  PPOs have network doctors, other health care providers, and hospitals, but you can also use out-of-network providers for covered services, usually for a higher cost.

Are prescription drugs covered?

In most cases, yes.  If you want Medicare drug coverage, you must join a PPO plan that offers prescription drug coverage (MAPD).

Do I need to choose a primary care doctor?

No.

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

In most cases, no.

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

• PPO plans are not the same as Original Medicare or Medigap (Medicare Supplement).
• Medicare PPO plans usually offer more benefits than Original Medicare, but you may have to pay extra for these benefits.
• If you need more information than listed here, check with the plan.  You can find the plan's member services telephone number by clicking on the "benefits & contact info" button on our MA-Finder.com.
  

Click here to learn more about Medicare Advantage Plans.