Medicare Advantage PPO

Carolina Insurance partners is your local medicare insurance broker

What Is Medicare Advantage PPO?

A Medicare PPO is a preferred provider organization. This means the insurance company has assembled a network of healthcare providers that will treat its members at contract-negotiated rates. Medicare PPO plans don’t usually require you to select a primary care physician (PCP) or to get a referral to see a specialist. As long as you see in-network providers, you will generally have lower co-pays.

Medicare PPO providers must also provide your Plan A and Plan B benefits and an out-of-pocket cap on your spending. This protects you from exorbitant spending in case you experience a year of more frequent medical expenses.

What You Need to Know Before You Enroll

You are free to see out-of-network doctors, but can expect to pay more for their care.

Some PPO plans include Part D prescription drug benefits.

You must review annual changes to the plan that take effect every year on January 1.

You must still pay for Medicare Part B and a monthly premium for the PPO plan itself. These premiums are sometimes as low as $0.

You must pay co-pays for medical services as you receive them. This includes doctor visits, lab work, hospital stays, surgeries, durable medical equipment, diagnostic imaging, and more.

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