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Medicare Advantage PPO Plan Costs

Medicare Advantage PPO Plans


What is a Medicare Advantage PPO Plan?

A Medicare Advantage PPO PPOplan, or a Preferred Provider Organization is offered by a private insurance company. PPO Plans have network doctors and hospitals. Individuals enrolled in this type of plan can use out-of-network providers for covered services, but usually for a higher cost.


PPO Plan types

There are two types of Medicare Advantage PPOs, a Regional PPOs, which is set by Medicare and serves one of 26 regions. A Local PPOs serve the counties the PPO Plan chooses to include in its service area.


Benefits Covered under a Medicare Advantage PPO Plan



Are prescription drugs covered?

In most cases, yes. Ask the plan administrator. If you want drug coverage, you must join a PPO Plan that offers prescription drug coverage.

Do I need to choose a primary care doctor?


Do I have to get a referral to see a specialist?



Medicare Advantage PPO Plan Costs

If you enroll in a PPO Plan, costs associated with the plan include the following:

  • The Medicare Part B premium (for 2012, the premium is $99.90 for most individuals. Those enrolled in Medicare Part B after January 1, 2011 or whose income exceeds certain limits will pay a higher Part B premium).
  • Part A and Part B , prescription drug coverage , and extra benefits above the Medicare Part B premium
  • Deductibles, coinsurance, or copays associated with the selected PPO Plan
  • Maximum amounts, or caps, for out-of-pocket costs in a Regional PPO (for both in- and out-of-network care). For Local PPO Plan, the plan may or may not have a cap.


(Information obtained from 






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