Preferred Provider Organization Plans (PPOs) are one of the many types of Medicare Advantage. Like other plans, it takes its own approach to helping individuals save more on their healthcare expenses.
PPO plans fulfill the criteria for what all Medicare Advantage plans must cover – everything that an Original Medicare policyholder can get, plus more. It offers coverage in a variety of settings, such as emergency rooms, doctors’ offices, and pharmacies. That’s because it combines the inpatient coverage of Medicare Part A, the outpatient coverage of Part B, and in most cases, the prescription drug coverage of Part D.
With a PPO plan, you can also enjoy benefits such as free gym memberships, dental care, vision treatments, and hearing services.
PPO plans stand out for a few main reasons – how they help save on medical costs, where policyholders can get treatment, and where it stands on primary care physician requirements.
This is the one Medicare Advantage plan that incentivizes you to use specific healthcare providers, instead of applying the same savings across an entire network. This is possible because some healthcare providers have a contract with Medicare Advantage, in which they agree to charge lower fees in exchange for more patients.
PPO plans allow you to get coverage outside of the network. However, you will pay more for out-of-network treatments. Some Medicare Advantage plans don’t allow for this at all – in fact, having a plan without this coverage can lead to healthcare professionals denying you non-emergency treatments. In other words, PPOs don’t have the same limitations that other Medicare Advantage plans do.
Also with PPO plans, you’re not required to choose a primary care physician, nor do you have to get referrals to see specialists.