Aabid K.

Medicare Preferred Provider Organizations (PPOs) are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, PPOs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some PPOs offer additional benefits, such as vision and hearing care.

Eligibility and costs basics

You must have both Parts A and B to join, and generally you will continue paying your Medicare Part B premium. Your PPO may also charge an additional premium, on top of the Part B premium. If you want Part D coverage, you will receive it through your PPO. Plans may charge a higher premium if you also have drug coverage.

Note: If you join a Medicare Advantage Plan and you want Part D coverage, you must receive coverage from your plan. You cannot enroll in stand-alone Part D coverage unless you join a Medical Savings Account (MSA) or Private Fee-for-Service (PFFS) plan that does not offer prescription drug coverage.

Benefits access basics

Once you have joined a PPO, you should receive a benefit card from your plan. You will use your PPO benefit card instead of your Medicare card when you go to the doctor or hospital.

After enrolling in a PPO you can see any provider, but you generally pay more when seeing out-of-network providers. PPO plans typically offer fixed copayments when you use the plan’s network.

There are two types of Medicare PPO plan:

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