What Does Local Preferred Provider Organization (LPPO) Mean in Insurance?

Local Preferred Provider Organization (LPPO) denotes a PPO-style health plan in which in-network clinicians and facilities serve a particular geographic region. Under this arrangement, you can still obtain services from providers outside the network, but doing so generally carries higher costs.

LPPO plans are offered by private insurers and create a localized panel of physicians and specialists. When you receive care from an in-network clinician or facility, the insurer typically covers a larger portion of the cost or you pay just a copayment. Visiting an out-of-network provider usually results in higher out-of-pocket expenses.

One convenience of LPPO plans is that you normally don’t need a referral from a primary care physician to see a specialist — you can schedule specialist appointments directly.

Continue reading to find out more about LPPO plans and how they compare to other available choices.

How does PPO differ from LPPO?

Depending on the insurer and your location, LPPO plans are sometimes labeled simply as PPO plans. These offerings commonly include a regional network of providers.

If you obtain services from a network member, those services are typically covered at a higher rate by the insurer or available for a fixed copay.

Both PPO and LPPO plans allow you to see specialists without a primary care doctor’s referral, unlike HMO plans that generally require referrals.

It’s also possible to find PPO-style Medicare Advantage plans.

What is an LPPO Medicare Advantage plan?

An LPPO Medicare Advantage (Part C) plan is a Medicare option administered by a private insurance company for beneficiaries.

LPPO or PPO Medicare Advantage plans usually give you greater freedom to choose providers, though that flexibility may come with higher costs. These plans often cost more than HMO Medicare Advantage plans, which typically require you to stay within the plan’s network for coverage.

In contrast, if you use an out-of-network provider under an HMO plan, you’ll most likely be responsible for the full cost of care.

Specific coverage details and costs depend on the individual plan.

Read more about the contrasts between PPO and HMO Medicare Advantage plans.

Which types of Medicare Advantage plans are available?

Medicare beneficiaries can choose from several Medicare Advantage plan types, including:

• HMO plans: These prioritize in-network care at a lower expense.
• PPO plans: PPOs vary costs based on whether services are delivered in-network or out-of-network.
• Private Fee-for-Service (PFFS) plans: PFFS plans let you see any Medicare-approved provider who agrees to accept the plan’s payment terms.
• Medicare Savings Account (MSA): MSA plans combine a high-deductible health plan with a medical savings account.
• Special Needs Plans (SNPs): SNPs provide tailored support for individuals with certain chronic conditions or those eligible for both Medicare and Medicaid.

Find out more about selecting the Medicare Advantage plan that fits your needs.

The bottom line

Local Preferred Provider Organization (LPPO) plans—also referred to as PPO plans—feature a network of providers serving a local area. You generally pay less when you receive care from an in-network provider, while using out-of-network services usually leads to higher personal costs.

PPOs do not require you to obtain a referral from a primary care physician to visit a specialist; you can schedule specialist care on your own.

For Medicare recipients, PPO/LPPO options are offered through Medicare Advantage plans administered by private insurers, who may also include extra perks like gym memberships or dental benefits.

Learn more about common Medicare terms and their meanings.