Preferred Provider Organization (PPO)
A Preferred Provider Organization (PPO) plan often appeals to people who like a certain amount of freedom in choosing their healthcare providers but also wants to keep their insurance costs fairly low. These plans are less restrictive than HMO plans. On the other hand, they usually require you to pay a somewhat higher out-of-pocket amount for the increased freedom.
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Benefits of Preferred Provider Organizations (PPOs)
- You choose your doctor (or other healthcare providers). The plan gives you an incentive to choose a doctor from within its network of providers but will cover a portion of the costs if you choose to see a doctor outside the network. (See the details below.)
- You do not need a referral to see a specialist.
Limitations of Preferred Provider Organizations (PPOs)
- You may end up paying more for your healthcare than under an HMO plan.
- If you choose a healthcare provider who is not in the PPO network, you will pay a higher percentage of the costs than you would for a network provider.
- Some providers may require that you handle claim forms. (Many, especially those in the PPO network, will file the forms for you.)
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Preferred Provider Organization (PPO) Product Features
Like an HMO, PPO plans are a “managed care” option. They have a network of doctors and other healthcare professionals which contract with the plan. You are encouraged, as a plan member, to use the PPO network.
Unlike the HMO plans, however, PPO plans will still cover a portion of your costs if you choose to go outside the network. If, for example, you see an in-network doctor for a routine visit, you might pay a small co-payment ($10 or $20 fee, say) or a deductible. If you visit a non-network doctor for the same routine visit, you might pay as much as 50 percent of the bill.
If you’re the kind of person who likes to choose your own specialist, without having to seek a referral from your primary care doctor, then a PPO plan may suit you best. This is an important difference from the HMO option, which does require your primary doctor to serve as a “gatekeeper” for any specialty care
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