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.

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2023 Medicare PPO Map

Vital Rx PPO

Monthly Premium*

$0

In-Network

Out-of-Network

Primary Care Physician

$0

Primary Care Physician

$50

Doctor on Demand

$0

Doctor on Demand

$0

Specialist Copayment

$45

Specialist Copayment

40%

Routine Annual Physical Exam Copayment

$0

Routine Annual Physical Exam Copayment

40%

Urgent Care Copayment

$60 worldwide coverage

Urgent Care Copayment

$60 worldwide coverage

Emergency Room Copayment1

$90 worldwide coverage

Emergency Room Copayment1

$90 worldwide coverage

Ambulance

$265

Ambulance

$265

Outpatient Surgery

$335-$390

Outpatient Surgery

40%

Physical Therapy

$40

Physical Therapy

40%

Inpatient Hospitalization

Days 1-4: $400 per day

Inpatient Hospitalization

40%

Dental reimbursement for all dental services:
Routine Cleaning/Restorative/Dentures (not for whitening)

$400 reimbursement

Vision: Annual Routine Eye Exam

$20

Vision: Annual Routine Eye Exam

40%

Frames/Lenses (per year)

$150 reimbursement

Hearing Care Solutions Hearing Aid Benefit

$599 or $899

Over-the-counter Benefit

$25 / quarter

Over-the-counter Benefit

Not available

Senior Fit Included

Yes

CDPHP Life Points® Rewards

Earn up to $125

Lab Services

$0 or $5

Lab Services

40%

X-rays

$40

X-rays

40%

Advanced Imaging Studies (CT, MRI, etc.)

$220

Advanced Imaging Studies (CT, MRI, etc.)

40%

OOP Max

$7,500

OOP Max (Combined)

$11,300

Plan Documents

Evidence of Coverage (EOC) and Summary of Benefits (SOB)

*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.