PPO Plans

What PPO Plans are

Preferred Provider Organization (PPO) Plans are a type of Medicare Advantage Plan. Like any Medicare Advantage Plan, you acquire it through private insurance. You’ll get all the benefits Original Medicare would give you, plus more.

What makes this unique is the incentive to see certain doctors and other healthcare practitioners. You will pay less for doctors in your plan’s network. In other words, those healthcare providers are the preferred providers (hence the plan’s name)

What you can do with this plan

Unlike the HMO Plan, you can see doctors outside your plan’s network. On the other side of that, you’ll pay more, but you will have this option available to you nonetheless.

Drug coverage is another feature, much like other Medicare Advantage Plans.

Choosing a primary care doctor isn’t always necessary. Many plans will not force you to choose a primary care doctor. Likewise, these plans often do not require referrals to see specialists.


Some plans may not have drug coverage. If your plan doesn’t offer drug coverage, you won’t be able to get drug coverage from a separate Medicare plan.

When to enroll

To enroll in a Medicare Advantage Plan, you need to be eligible or enrolled in Original Medicare. You also need to be aware of the enrollment periods:

  • Initial Enrollment Period: The Initial Enrollment Period is a seven-month period that starts your Medicare eligibility. It begins three months before your 65th birthday, and ends three months after. 
  • Annual Enrollment Period: AEP begins on October 15 and ends December 7 of every year. During this period, you have the option to make changes to your Medicare coverage, such as switching from Original Medicare to Medicare Advantage. If you’re currently enrolled in Medicare Advantage, you also have the option to switch to a different Medicare Advantage Plan.
  • Special Enrollment Period: The SEP can be triggered in several ways, but is ultimately unique to the individual’s situation. It is best to speak with a Medicare agent to determine if you do qualify for a SEP, but one of the most common reasons beneficiaries do qualify for this period is because they moved out of their plan’s service area and need a new plan. If you do qualify for this period, you have the option to make changes to your Medicare Advantage Plan, or you switch back to Original Medicare.

For further information about Medicare Advantage and PPO Plans, call me today at (407) 924-8109. You can also email me at dale@medicareplans4us.com