Travel coverage
Unlike HMO plans, PPO plans often provide coverage for health care while you’re away from home.
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What is a Medicare Advantage PPO?
Many Medicare Advantage insurance providers offer two types of plan structures: Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO). HMO plans require that policyholders use their network of hospitals, doctors, and other healthcare professionals with exceptions only for emergencies. PPO plans, on the other hand, have similar networks but policyholders are not required to use in-network providers.
Medicare Advantage PPO plans offer more freedom of choice than HMO plans. If you use their in-network providers, your costs may be lower, but you are much less limited in choosing your care, and will also have better and more flexible coverage while traveling.
Medicare PPO benefits and features
Prescription Drug Coverage
Some Medicare Advantage PPO plans cover prescribed medications.
Dental Coverage
Preventative dental care, such as checkups and cleanings, may be covered.
Vision Coverage
Eye exams and other vision benefits may be available with Part C PPO plans.
Compare Medicare Part C plans
| Coverage | HMO Plans | PPO Plans | SNPs |
| Charges monthly premium | Yes | Yes | Yes |
| Covers prescription drugs | Sometimes | Sometimes | Yes |
| Allows out-of-network coverage | Sometimes | Yes | Sometimes |
| Requires primary care physician | Sometimes | No | Sometimes |
| Requires referrals for specialist care | Yes | No | Sometimes |
Frequently asked questions about Medicare Advantage PPOs
Who is eligible for Medicare PPO plans?
Medicare Part C plans, including Medicare Advantage PPO plans, are available to anyone eligible for Original Medicare (Parts A & B, through the federal government). Medicare is available to U.S. citizens qualifying by age or special qualifying conditions.
- Age: If you are a citizen of the United States who has been living in the U.S. for the previous 5 years and are 65 years of age (or approaching your 65th birthday) you are eligible to sign up for Medicare.
- Qualifying Conditions: You may qualify for early benefits if
- you are disabled and have received Social Security benefits for at least 24 consecutive months;
- you suffer from kidney failure, also known as End-Stage Renal Disease (ESRD), and have had a kidney transplant or been on dialysis for 3 months; or
- you have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
How do I enroll in a Medicare PPO?
Enroll in a Medicare Advantage PPO plan during a qualified Medicare Enrollment Period. Here are a few of the most common times of year to enroll in, or change, your Medicare Part C coverage:
- Annual Enrollment Period - October 15-December 7 each year, available to anyone Medicare-eligible
- Medicare Advantage Open Enrollment Period - January 1-March 31 each year, available to anyone already enrolled in a Medicare Advantage plan
- Special Enrollment Periods - may occur throughout the year, triggered by qualifying events
To enroll in a plan, you can compare online or speak to an agent by calling 1-855-200-9406 between 6:00 am and 5:00 pm MT, Monday through Friday.
Do Medicare PPO plans charge a monthly premium?
Yes, Medicare Advantage PPO plans do charge a monthly premium. Monthly premiums associated with PPO plans are generally higher than those associated with HMO plans due to the broader range of coverage.
Are prescription drugs covered by Medicare PPOs?
Some, but not all, Medicare Advantage PPO plans cover prescription drugs. If you prefer an HMO plan with prescription drug coverage, speak to an agent by calling 1-855-200-9406 between 6:00 am and 5:00 pm MT, Monday through Friday. Let the agent know your preference and they can help you find the plan that fits.
Can I use any doctor or hospital that accepts Medicare for covered services?
Unlike HMO plans, which have required provider networks, PPO plans allow you to use any doctor or hospital that accepts Medicare for covered services. However, if you use a provider or hospital outside the PPO network, there may be additional costs for care.
Do I need to choose a primary care provider (PCP)?
No, with PPO plans you do not need to choose a primary care provider (PCP).
Do I have to get a referral to see a specialist?
No, with PPO plans you do not need to get a referral to see a specialist.
Are my Medicare PPO options limited based on the state I live in?
All Medicare Advantage plans must offer equivalent coverage to that provided by Original Medicare (Parts A & B) through the federal government. What varies plan-by-plan are the additional benefits available and their associated costs.
To learn what’s available in your area, speak to an agent by calling 1-855-200-9406 between 6:00 am and 5:00 pm MT, Monday through Friday.
Medicare resources
Medicare Advantage Plans
Learn about Medicare Advantage, also referred to as Medicare Part C, coverage.
Medicare Annual Enrollment Period 101
When is the Medicare Annual Enrollment Period? Get answers to this and other AEP-related questions.
Medicare Enrollment Overview
Get fast facts about Medicare Enrollment, including when you qualify and when to enroll.