Medicare Advantage PPO plans allow you to see both in-network and out-of-network providers. Here’s how they work.
Updated Jun 1, 2022 · 2 min read Written by Kate Ashford, CSA® Lead Writer Kate Ashford, CSA®
Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 20 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Assigning Editor Holly Carey
Assigning Editor | Medicare
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
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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. But 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 (38%) of Medicare Advantage plans are Medicare PPO plans.
Medicare Advantage is a bundled alternative to Original Medicare and is 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 ( Part D ), and often additional benefits like some coverage for dental and hearing care.
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.
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.
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.
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.
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.
MEDICARE ADVANTAGE is an alternative to traditional Medicare offered by private health insurers. Compare options from our Medicare Advantage roundup .
Best for size of network
Best for low-cost plans
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Star ratings from CMS and on a 5-★ scale.
A Medicare Advantage PPO plan 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 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).
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Kate Ashford is a certified senior advisor (CSA)® and personal finance writer at NerdWallet specializing in Medicare and retirement topics. See full bio.
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