What Is the Difference Between PPO and Regional PPO Medicare Advantage Plans?

Of the five types of Medicare Advantage plans on the market, PPO plans are the most popular. These plans have a network of providers you can choose from and offer benefits outside of the network. Not all Medicare Advantage plans allow for that, but the PPO option does.

Did you know there are a couple of different types of PPO plans as well? 

How PPO Plans Work

Private insurance companies offer Medicare Advantage PPO plans. PPO members are given a choice of providers and hospitals within the plan's network. These programs also allow you to seek care outside the network, but your out-of-pocket costs will be higher.

PPO networks must provide a certain number of physicians and doctors in all of the 26 medical specialties, plus some for chiropractic services. These also must be within a certain about of driving time and distance from their members. (This is why all plans are not available in all geographical locations.)

The other benefit to these plans is that you do not have to choose a Primary Care Physician (PCP). In addition, your PCP will not need to provide a referral to a specialist - you may see one of your own accords.

Local PPO Plan

As the name implies, a local PPO has a small geographical area. This area usually encompasses an entire county (or part of one if there is a city with a large population) and will include anywhere between 2000 to 5000 providers.

Regional PPO Plan

Regional PPO plans have a much more extensive network. A region is defined by the government, not the PPO plan. It may include urban and rural areas and 16,000 - 17,000 providers!

When choosing a PPO plan, make sure you know which type of PPO you are enrolling in. Before you complete the enrollment, it's a great idea to check with your current providers to see if they are in the network. If they're not, you'll have to decide if it's worth paying more out-of-pocket to continue care with them.