Medicare PPO Plans

PPOs have two out-of-pocket limits: one for in-network care and a higher combined limit for all covered care. If you plan to use out-of-network providers, compare the combined limit.

Source: CMS 2027 landscape data as reported by Becker’s, October 1, 2026.

Medicare Advantage, also called Part C, is a way to get your Medicare benefits through a private insurance company approved by Medicare. The plan covers everything Original Medicare Part A and Part B cover, except hospice care, which Original Medicare still pays. Most plans also include Part D drug coverage, and many may add extras such as routine dental, vision and hearing benefits.

In exchange, Medicare Advantage plans generally use networks of doctors and hospitals, and may require referrals or prior authorization for some services. Every Medicare Advantage plan has a yearly out-of-pocket maximum for covered medical care, which Original Medicare does not have. You keep paying your Part B premium, plus your plan’s premium if it has one.

If your plan will not be offered in your county for 2027, you should have received a non-renewal notice in early October. Your coverage does not stop right away: it continues through December 31, 2026, so you have time to choose.

Plans must send the Annual Notice of Change by September 30. It is the single most useful document you get each fall, because it tells you exactly how your plan changes on January 1.

Outside the fall and early-year windows, you generally need a Special Enrollment Period to change plans. Common reasons include:

Each Special Enrollment Period has its own time limit, so act as soon as the event happens.

Most Medicare Advantage plans require prior authorization for some services, such as certain surgeries, advanced imaging, skilled nursing stays and some drugs. Your doctor usually requests it, but ask whether a planned service needs approval so a denial does not surprise you.

If a request is denied, you or your doctor can appeal. Medicare rules set deadlines for plans to decide, with faster deadlines when waiting could seriously harm your health.

Every Medicare Advantage plan covers emergency care and urgent care anywhere in the U.S., in or out of network, and you do not need prior approval for an emergency. Routine care away from home is a different story: HMOs generally do not cover it, while PPOs cover out-of-network care at a higher cost.

If you spend months away from home each year, ask each plan how it handles care in your second location. It is one of the most common reasons people switch plans mid-year.

If your plan denies a service, a drug or payment for care, you have the right to appeal. The plan’s denial notice explains how. There are several levels of appeal, starting with the plan and moving to independent reviewers.

For problems that are not about coverage, such as customer service or wait times, you can file a grievance with the plan. You can also contact 1-800-MEDICARE or your State Health Insurance Assistance Program for help.

The Part B premium is the one big number not released with the plans. CMS normally announces it in November. The 2026 Medicare Trustees Report projects a 2027 standard premium of about $209.50 a month and a deductible of about $292, up from $202.90 and $283 in 2026. You keep paying it with Medicare Advantage.

If you miss the Annual Enrollment deadline, your current plan renews automatically for 2027, with the changes in your Annual Notice of Change. If you are in Medicare Advantage, you get one more chance from January 1 to March 31, 2027, to switch Medicare Advantage plans or return to Original Medicare and join a Part D plan.

You do not have to compare plans alone, and you should not have to pay for help. These are the free options:

Before any call, have your Medicare card, your list of drugs and doses, your doctors and your preferred pharmacies ready. It turns a long conversation into a short one.