Preferred Provider Organization (PPO)

How Preferred Provider Organization (PPO) Work in West Virginia

A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C)

 offered by private insurance companies. PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You can also use out-of-network providers for

covered services, usually for a higher cost, if the provider agrees to treat you and hasn’t opted out of Medicare (for Medicare Part A and Part B items and Services). You’re always covered for emergency and urgent care. Can you get your health care from any doctor, other health care provider, or hospital? In most cases, you can get your health care from any doctor or other health care provider. Or hospital in PPO Plans. Each plan allows you to go to doctors, specialists, or hospitals that aren’t on the plan’s list, but it will usually cost more. 

Are prescription drugs covered?

In most cases, prescription drugs are covered by Preferred Provider Organization (PPO). Ask about the plan. If you want Medicare drug coverage, you must enter a PPO Plan that offers prescription drug coverage. If you join a PPO Plan that doesn’t offer prescription drug coverage, you can’t join a  

Medicare Drug Plan (Part D)

Do you need to choose a primary care doctor?

You don’t need to select a primary care doctor in Preferred Provider Organization (PPO).

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

In most circumstances, no. But if you use plan specialists (in-network), your expenses for covered services will usually be lower than those of non-plan specialists (out-of-network).

What else do you need to understand about this type of plan?

• Because certain providers are “preferred,” you can save money utilizing them.
• Check with the plan for additional information.