Medicare PPOs (Preferred Provider Organizations) must offer all Medicare Part A and Part B benefits. Part A is Medicare hospital insurance, and Part B is Medicare outpatient insurance. They usually also offer Medicare Part D benefits. Part D is Medicare’s outpatient prescription drug benefit. If you are in a PPO, and you want Medicare drug coverage, you must get it from the same plan you receive your health coverage from. Some PPOs offer additional benefits that Original Medicare does not cover, such as vision and dental care.
In a Medicare PPO you must use providers in the PPO's network to have the lowest costs (except in emergency situations). PPOs must cover out-of-network services, but you may pay more if you go out of the plan’s network. In a PPO you can see specialists without a referral from your Primary Care Physician (PCP).
PPOs are limited in how much they can charge you for copays. However, for some types of care they may charge more than Original Medicare. Care that they can charge you more for include: home care and skilled nursing facility services.
Plans must have an annual out-of-pocket limit on how much you pay. PPOs have two different out-of-pocket limits for in-network and out-of-network care. These limits can be high, but will protect you from excessive costs if you use a lot of care or need expensive treatments.
Call your plan to find out if you are covered for emergency services in a foreign country.
For more information on Medicare PPOs, click on the links in the GO TO box.