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A Medicare Advantage preferred provider organization, or PPO, plan is a health insurance plan that offers care through a network of medical providers and facilities. Unlike a health maintenance organization, or HMO, you can seek care outside the network, although it will usually be more expensive. Also, PPO plans typically don’t require referrals to see a specialist.
More than a third (roughly 43%) of Medicare Advantage plans are Medicare PPO plans.
What is Medicare Advantage?
Medicare Advantage is a bundled alternative to Original Medicare. It's sold by private health insurance companies contracted with the federal government.
Medicare Advantage plans include all the Medicare Part A and Part B benefits, usually prescription drug coverage (Medicare Part D), and often additional benefits like some coverage for dental and hearing care.
Compare Medicare Advantage plans
| Insurance company | CMS Star Rating | States available | Members in high-rated plans | Member experience |
|---|---|---|---|---|
| 4.11 /5 | 48 states and Washington, D.C. | Medium (50% to 84%) | 3.74 (Above average) | |
| 3.79 /5 | 46 states and Washington, D.C. | Low (49% or less) | 3.82 (Above average) | |
| 4.2 /5 | 43 states and Washington, D.C. | Medium (50% to 84%) | 3.89 (Above average) | |
| 3.76 /5 | 29 states and Washington, D.C. | Medium (50% to 84%) | 3.96 (Above average) |
How do Medicare Advantage PPO plans work?
With a Medicare Advantage PPO plan, you can get affordable care from a network of doctors and hospitals. These medical providers and facilities have contracted with the plan to provide services for specific prices.
PPO plans also allow you to seek out-of-network care. That means you can see any doctor or visit any hospital you want, but you’ll pay more for covered services outside the provider network. In addition, unlike Medicare HMO plans, PPO plans don’t require you to choose a primary care physician or get referrals before seeing a specialist.
» MORE: Best Medicare Advantage plans
Advantages of a Medicare Advantage PPO plan
More flexibility
Because you can seek out-of-network care, you can see any doctor or visit any medical facility you want. This gives you more options, although generally, you’ll want to use in-network care to keep costs down.
No referrals needed
If you want to see an in-network specialist — or out-of-network specialist, for that matter — you can just make an appointment. There’s no need to coordinate your care through a primary care physician.
Disadvantages of a Medicare Advantage PPO plan
More expensive
PPO plans tend to have higher premiums than other types of plans, and there may be a deductible you must meet before the insurance starts covering care.
DIY care management
Although it’s freeing to be able to seek care without the approval of a primary care physician, it also means you’re solely responsible for overseeing your health care. This could be more burdensome if you have complex medical needs.
Shopping for Medicare Advantage plans? We have you covered.
| MEDICARE ADVANTAGE is an alternative to traditional Medicare offered by private health insurers. Compare options from our Medicare Advantage roundup. | |
| Best major company | Best for size of network |
| Best government ratings | Best for low-cost plan availability |
Is a Medicare Advantage PPO plan better than an HMO plan?
A Medicare Advantage PPO plan has advantages, but isn’t the best choice for everyone. Consider a PPO if the following situations apply:
- You don’t want to get referrals to see a specialist.
- You want the option of seeking out-of-network care.
- You can afford the monthly premiums, which may be higher than other plans.
- You can afford the deductibles, copays and coinsurance required if you seek care.
Medicare Advantage plans by state
Medicare Advantage plan availability varies by location. Click on a state on the map below to see the best Medicare Advantage plans available in that state.
To compare Medicare Advantage PPO plans (and other Medicare plans), visit Medicare’s plan finding tool.
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
