Medicare Advantage PPO Plans

A PPO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PPOs have networks of doctors, other health care providers, and hospitals.

• You pay less if you go to providers and facilities that are belong to the plan’s network.
• You can generally go to out-of-network providers for covered services, but you’ll usually pay more.
• Many PPO plans include Part D drug coverage. If you choose a plan that doesn not, you can not buy a separate Part D plan.
• You do not need to choose a primary Care doctor.
• Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
• If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment is medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.

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