PPO Plans Explained

You’d like to get flexible and comprehensive health coverage. Do you also like saving money? PPO plans may be the right health insurance choice for you.

Preferred Provider Organizations — or PPOs — are networks of doctors, hospitals, and other healthcare providers. The health plans associated with PPOs save you money when you use a provider “within the network.” But they will also provide you with coverage when you get services from “outside the network.”

PPO plans are a combination of managed care and traditional indemnity plans. With their networks of providers, PPO plans have a lot in common with HMO plans. But in a PPO plan, you don’t choose a Primary Care Provider. This is the major difference between PPO plans and POS plans.

Since in a PPO plan you don’t have a Primary Care Physician, you don't need a referral for specialist care. There is a higher copayment if you need health care from outside of your PPOs network.

What Are the Advantages?

• Your PPO Plan will limit your annual out-of-pocket costs
• You’ll be free to consult any medical specialist you’d like to, including those outside your PPO Network
• Your overall health care costs will be low whenever you use the PPO network’s doctors and hospitals

And The Disadvantages?

• You'll need to meet a deductible before coverage kicks in
• If you seek treatment outside of your PPO Network, it will be more expensive
• Your PPO’s co-payment rates will generally be greater than those of other managed care plans

Greater Flexibility — And Greater Cost

The more flexibility and choice a health plan offers, the bigger the price tag. So a PPO plan will cost more than an HMO plan.

Even if you select a plan with low premiums, there may be other fees that increase your healthcare costs. Your premium alone is not a good measurement of your yearly medical costs.

For example: In addition to your monthly premiums, you will probably have to pay coinsurance fees — unless you’re making use of a preventive health service. You’ll also need to meet a deductible before your PPO Plan begins to cover your care.

Finding The Right Plan For You

A good PPO Plan can be worth the extra cost. When you need flexibility, the choices they offer can be hard to put a price tag on.

If you think a PPO is right for you, you should talk with professional insurance agents. Our free service will match you with local agents who can help you choose the right plan. All you have to do is fill out a short form to request free health insurance quotes. The agents we work with will help you find a plan that meets your needs and your budget.