Preferred Provider Organization (PPO) plans are offered under the federal Medicare Advantage program. PPO plans provide Individual and Group Retiree Medicare beneficiaries an array of health care choices, often with more benefits than those provided by Original Medicare. Plan members are still covered under the Medicare program and have federally regulated rights and protections.
PPO plans are available as either a Local PPO (LPPO) or Regional PPO (RPPO) offerings. A Local PPO covers certain counties within a state while a Regional PPO serves a larger geographic area (either a single state or a multi-state area). A Regional PPO offers the same premiums, benefits and cost-sharing requirements to all members in the region.
While the exact benefits will vary depending on the specific plan, PPO plans offer the following features and benefits:
- Plans starting at a $0 monthly premium
- Annual limits on out-of-pocket health expenses
- Access to a network of local doctors and hospitals
- Flexibility to see out-of-network physicians, hospitals and other health care professionals for all covered services generally for a higher copayment or coinsurance
- Access to specialists and out-of-network providers without a referral
- Coverage for many preventive services annually for a $0 copayment, including an annual routine physical
- Worldwide coverage for emergency care
- 24-hour NurseLine service
- Coverage for additional preventive services such as routine vision, hearing and dental (availability varies by plan)
- Integrated Medicare Part D prescription drug coverage (Not available in all plans).
Individual UnitedHealthcare Medicare Advantage PPO plans are only offered in certain areas. The Individual Local PPO plans are available in select counties in 13 states, while the Individual Regional PPO plans are available in all counties in the states in which they are offered:
Individual Local PPO: FL, HI, ID, IL, IN, ME, MO, NC, NM, NY, OR, PA, TX
- Individual Regional PPO: FL, HI, NY, and CT/MA/RI/VT
UnitedHealthcare® Group Medicare Advantage PPO plans are only offered to groups, such as employers, unions and government sub-entities. Benefit plans are often unique to each group. The Employer Group Local PPO plans are available in select counties in 42 states, while the Employer Group Regional PPO plans are available in all counties in the states in which they are offered. If a group qualifies via the Employer Group Waiver, its plan is available nationwide and is referred to as a National PPO (NPPO).
Employer Group Local PPO: AL, AR, AZ, CA, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, NC, NE, NH, NJ, NM, NY, OH, OR, PA, RI, SC, TN, TX, UT, VA, VT, WA, WI, WV
Employer Group Regional PPO: HI, NY
Employer Group National PPO: Nationwide, if group qualifies via Employer Group Waiver