PPO Coverage: What Does Medicare PPO Plan Cover?

Medicare Preferred Provider Option Plans (PPOs) are one type of Medicare Advantage Plan. Some PPO plans do not have a prescribed network, but charge more up-front for monthly premiums. Most PPOs do have prescribed networks of doctors and hospitals. Patients can go outside of the network but this results in a higher out-of-pocket expenses. Some PPO plans offer prescription drug coverage while others do not. Some plans offer extra benefits such as vision, dental, and chiropractic insurance. What you can expect to pay for a monthly premium depends on the type of PPO plan you buy and what kinds of extra benefits you receive in your plan.

Medicare PPO Plan Covers Original Medicare Benefits

By default, PPOs must provide benefits that are included under Original Medicare plans. Original Medicare Plans include Parts A (hospital) and B (outpatient) insurance. Part insurance covers diagnosis and treatment in the hospital, including hospital visits and drugs prescribed by the doctor in the hospital. There are very strict rules concerning what Part insurance covers. For example, Part A insurance will not cover orthopedic shoes, unless the patient is diabetic. In addition, there are hospital conveniences (such as television) that Part insurance will not cover.

Part B insurance covers outpatient treatment and diagnosis. That is, medical services (like outpatient surgeries) or equipment that is vital to the treatment of the patient will be covered under Part B insurance. Chemotherapy is a necessary treatment for cancer patients that would be covered under Part B insurance. An oxygen tank for asthmatic patients is a good example of a form of medical equipment that would be covered under Part B insurance. One requirement of Parts A and B insurance is that services and equipment covered under both parts cannot be mere conveniences for the patient. Rather, coverage of Parts A and B insurance only applies to necessary, essential services and equipment. Parts A and B insurance are not only guaranteed with Original Medicare Plans, but also Preferred Provider Option Plans (PPOs) because PPOs must provide essentially the same benefits as Original Medicare. They can also add on various other benefits that are not covered under Original Medicare.

Medicare PPO Plans Cover Extra Benefits

In addition to covering Parts A and B insurance (the same as Original Medicare), Preferred Provider Options (PPOs), a form of Medicare Advantage Plans, also cover additional benefits. Some types of extra benefits that are often covered are vision, dental, hearing, chiropractic, prescription drugs, etc. Not all PPO Plans cover the same extra benefits. Some provide prescription drugs while others do not; some provide a network of doctors while some do not; others provide vision and dental while not covering chiropractic and other medical services.

Medicare PPOs coverage is distinguished from Original Medicare mainly by the extra benefits they provide. While these benefits provide great medical care, they do not come without costs that are built into the plan