PPO plans
Flexibility to see out-of-network providers at higher cost. No referral needed for specialists. Combined in/out-of-network MOOP applies.
What it covers
- What it pays for
- Combines A, B, often D, plus extras; see any Medicare-accepting provider, in- or out-of-network.
- How it works
- Lower cost in-network; out-of-network allowed at higher cost sharing. No referral needed.
- Who can get it, and when
- No health underwriting; election periods (AEP, OEP, SEP) apply.
What it costs
A premium that varies by plan, then copays and coinsurance until you reach the plan's out-of-pocket maximum.
Hawkins Insurance Group, LLC is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
What is good about it
- Travel-friendly with broader provider access
The catch
- Higher MOOP potential when out-of-network costs count
- Premiums often higher than HMO
PPO plans and HMO plans
| What is compared | PPO plans | HMO plans |
|---|---|---|
| Premium | Often higher | Often lower |
| Out-of-network coverage | Yes (higher cost) | Emergency only |
| Specialist referral | Not required | Required |
| Typical out-of-pocket maximum | Typically higher | Typically lower |
Mistakes to avoid
- Using out-of-network providers without checking how much more the cost sharing is
- Paying higher premiums for PPO flexibility you rarely use
Common questions
- If you travel frequently, want specific specialists without referrals, or live in areas with limited in-network options.