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Prefered Provider Organization (PPO)
PPO insurance lies between HMOs and pure fee-for-service plans. Your health care is managed ,as well as
restricted but you are granted a degree of choice in providers. A PPO health insurance plan operates
like an HMO in that you pay a fixed monthly premium, and, in return, the health insurance company and
its health care network provide basic medical benefits to you.
However, a PPO does differ from the original HMO blueprint, primarily in that under a PPO insurance
plan, a primary care physician is not required. As a result, seeing a specialist does not require a
referral. If you need or want health care from outside the network, you should expect to pay a higher
co-payment than if the provider were from within the PPO network.
In essence, each time you need medical attention, you can decide between an higher costing indemnity
plan with total freedom of choice over care or a lower costing HMO plan that restricts your care to
within a network.
Advantages of PPO insurance
• Health care costs are low when using the PPO networks.
• You can consult any specialist, including ones outside the plan.
• Seeing a primary care physician is not a prerequisite.
• Paperwork is your responsibility if the care is non-network.
• Out-of-pocket costs per year is limited.
Disadvantages of PPO insurance
• Cost of treatment outside of network is more expensive.
• Co-payments are larger than with other managed care plans.
• You may need to satisfy a deductible.
The Cost of PPO Insurance
PPO insurance is generally the most expensive type of managed care plan. Even with a premium comparable
to that of. say, an HMO, the other fees associated with PPO insurance can increase its cost
significantly. On top of the premium, you can expect to pay coinsurance (lower charges if using network
providers and higher charges if using non-network providers). For preventative services, co-insurance is
usually waived and, instead, but may be replaced with a (low) co-payment. With non-network care, you
must satisfy a deductible before the health insurance company begins contributing. After the deductible
is met, you pay a higher percentage of the cost and may also be require to pay the difference between
what the health care provider charges and what the plan deems to be "reasonable and customary" for the
service. It's simply important to note that premiums alone are not an accurate indicator of your
potential yearly medical costs under a PPO insurance plan.
Compare PPO Providers
PPO Insurance Directory of Products and Services
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