Medicare Advantage
PPO Plans
Flexibility to see out-of-network providers at higher cost. No referral needed for specialists. Combined in/out-of-network MOOP applies.
The quick version
If you only read one thing, read this
- 1
Combines A, B, often D, plus extras; see any Medicare-accepting provider, in- or out-of-network.
- 2
Premium range $0–$70+/month; copays/coinsurance until MOOP. Out-of-network costs are higher.
- 3
No health underwriting; election periods (AEP, OEP, SEP) apply.
The details
The stuff that matters, one piece at a time
Benefits
Combines A, B, often D, plus extras; see any Medicare-accepting provider, in- or out-of-network.
What it costs
Show me the money
- Plan Premium Range
- $0–$70+ USDHigher flexibility costs more
- In-Network MOOP Range
- $3,500–$9,250 USDFederal max $9,250 for 2026
- Part B Premium Still Owed
- $202.90 USDMust pay Part B premium in addition to plan premium
- In-Network MOOP
- $4,000–$8,300Plan-specific
- Combined In/Out MOOP
- Up to $13,900Federal combined max for 2026; in-network alone is capped at $9,250. Out-of-network costs count toward this
The honest take
What's good, and where it falls short
The good stuff
- Out-of-network flexibility without referrals
- Travel-friendly with broader provider access
- Can see any Medicare provider at some cost level
The catch
- Higher MOOP potential (combined up to $13,900)
- Premiums often higher than HMO
- Out-of-network costs significantly higher
Head to head
PPO Plans vs. HMO Plans
PPO offers broader access; HMO is often more affordable.
Buyer beware
The mistakes that cost folks the most
Using out-of-network providers without realizing cost sharing may be 40–50% higher
Not understanding the combined in/out-of-network MOOP. Out-of-network costs count, but at higher rates
Paying higher premiums for PPO flexibility you rarely use
Common questions
What folks ask us most
Keep learning
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The Insurance Hawk
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