Medicare Advantage PPO Plans
Preferred Provider Organization plans give you the flexibility to see any doctor while saving money when you stay in-network. Get the freedom you want with the coverage you need.
What Is a Medicare Advantage PPO?
A Preferred Provider Organization (PPO) is a type of Medicare Advantage plan that contracts with a network of doctors, hospitals, and other healthcare providers. When you use providers inside the network, you benefit from lower out-of-pocket costs. However, unlike an HMO, a PPO also covers care from out-of-network providers — you'll just pay more for that flexibility.
PPO plans are a popular choice for people who want a balance between cost savings and provider choice. You don't need referrals to see specialists, and you can visit any Medicare-accepting provider in or out of the network. This makes PPOs especially appealing if you travel frequently, split time between states, or want to keep seeing a doctor who may not be in every plan's network.
Like all Medicare Advantage plans, PPOs must cover everything Original Medicare covers. Most also include Part D drug coverage, and many offer additional benefits like dental, vision, hearing aids, and wellness programs.
In-Network vs. Out-of-Network: How It Works
In-Network Providers
- Lower copays for office visits and specialist appointments
- Reduced coinsurance for hospital stays and procedures
- Lower out-of-pocket maximum protects you from high costs
- Coordinated care between your doctors within the network
- No referral needed to see in-network specialists
Out-of-Network Providers
- Higher copays and coinsurance than in-network visits
- Separate (higher) out-of-pocket maximum may apply
- Provider must accept Medicare and agree to treat you
- Ideal for travelers or those seeing specialists in other areas
- No referral or prior authorization for most services
Key Advantages of PPO Plans
In-Network Savings
You pay lower copays and coinsurance when you visit doctors, specialists, and hospitals within the plan's preferred provider network.
Out-of-Network Freedom
Unlike HMO plans, PPOs allow you to see out-of-network providers without a referral — you'll simply pay a higher cost share.
No Referral Requirement
Visit specialists directly without needing a referral from your primary care physician, giving you faster access to the care you need.
Nationwide Coverage
Many PPO plans offer coverage when you travel or spend part of the year in another state, making them ideal for snowbirds and frequent travelers.
Prescription Drug Coverage
Most Medicare Advantage PPO plans include Part D prescription drug benefits, so you won't need a separate drug plan.
Extra Benefits Included
Enjoy additional perks such as dental, vision, hearing, fitness memberships, telehealth, and over-the-counter allowances.
Is a PPO Plan Right for You?
A Medicare Advantage PPO plan may be the best choice if you value flexibility and don't want to be restricted to a single provider network. Consider a PPO if:
- You want the freedom to see any Medicare-accepting doctor without a referral, even if they're out of network.
- You travel frequently or split your time between Florida and another state and need coverage that follows you.
- You have established relationships with specialists who may not be in a particular HMO's network.
- You want the financial protection of an out-of-pocket maximum that Original Medicare doesn't provide.
- You're willing to pay slightly higher premiums or cost shares in exchange for greater choice and convenience.
Our licensed agents at MAC Insurance will review your current doctors, medications, and healthcare needs to determine whether a PPO plan — or another plan type — is the best fit for your situation.
Find the Best PPO Plan for You
Our licensed agents will compare PPO plans in your area, verify your doctors are in-network, and help you find the right balance of flexibility and savings — at no cost to you.