A Medicare PPO (Preferred Provider Organization) is a type of Medicare plan that offers flexibility in how you receive care. The insurance company contracts with a network of healthcare providers who agree to provide services at negotiated rates. Unlike HMOs, Medicare PPO plans typically do not require you to choose a primary care physician or obtain referrals to see specialists. Using in-network providers usually results in lower copayments and out-of-pocket costs.

Medicare PPO plans also cover all Medicare Part A and Part B benefits and include an annual out-of-pocket maximum. This spending cap helps protect you from high medical costs during years when you may need more frequent care.

• You may visit out-of-network providers, but doing so typically results in higher out-of-pocket costs.
• Some Medicare PPO plans include Part D prescription drug coverage.
• It’s important to review your plan’s annual updates, as changes to benefits and costs take effect each year on January 1.
• You must continue paying your Medicare Part B premium, along with any monthly premium required by the PPO plan. In some cases, plan premiums may be as low as $0.
• Copayments are required at the time services are received, including doctor visits, lab tests, hospital stays, surgeries, durable medical equipment, diagnostic imaging, and other covered services.