Could a Medicare Advantage PPO plan be right for you?

PPO plans offer coverage for both in-network and out-of network providers. So if you spend extended periods of time away from home, a PPO plan might be a good fit. You also won't need to designate a primary care physican (PCP) with these plans.

Check out the Medicare Advantage PPO plans listed below to see which one may best fit your needs.

Compare Plans


2023 Medicare PPO Map

Complete Rx PPO

Monthly Premium*

$70

In-Network

Out-of-Network

Primary Care Physician

$0

Primary Care Physician

$40

Doctor on Demand

$0

Doctor on Demand

$0

Specialist Copayment

$40

Specialist Copayment

30%

Routine Annual Physical Exam Copayment

$0

Routine Annual Physical Exam Copayment

30%

Urgent Care Copayment

$55 worldwide coverage

Urgent Care Copayment

$55 worldwide coverage

Emergency Room Copayment1

$120 worldwide coverage

Emergency Room Copayment1

$120 worldwide coverage

Ambulance

$255

Ambulance

$255

Outpatient Surgery

$275-$325

Outpatient Surgery

30%

Physical Therapy

$40

Physical Therapy

$60

Inpatient Hospitalization

Days 1-6: $310 per day

Inpatient Hospitalization

30%

Dental Allowance on a prepaid Benefits Mastercard to use at any dentist in the U.S. for all dental services, routine cleaning/restorative/dentures (not to be used for teeth whitening):

$1,400

Vision: Annual Routine Eye Exam

$20

Vision: Annual Routine Eye Exam

30%

Frames/Lenses on a prepaid Benefits Mastercard (per year)

$225

Hearing Care Solutions Hearing Aid Benefit (per ear)

$599 or $899

Over-the-counter Benefit on a prepaid Benefits Mastercard

$50 / quarter

Over-the-counter Benefit on a prepaid Benefits Mastercard

Not available

Senior Fit Included

Yes

CDPHP Life Points® Rewards

Earn up to $125

Lab Services

$0 or $5

Lab Services

30%

X-rays

$5

X-rays

$40

Advanced Imaging Studies (CT, MRI, etc.)

$135

Advanced Imaging Studies (CT, MRI, etc.)

30%

OOP Max

$6,000

OOP Max (Combined)

$10,100

Plan Documents

Evidence of Coverage (EOC) & Summary of Benefits (SOB) Information

View a side-by-side comparison

Medicare Advantage Plan Options

Medicare Advantage Plan Options – Western NY

*You must continue to pay your Medicare Part B premium; You may qualify for lower premiums with EPIC or Low Income Subsidy.


Disclaimer:

  1. Copayment waived if admitted to the hospital within 24 hours for the same diagnosis.