What is so Special about PPOs?
A PPO, or Preferred Provider Organization, is a collection of hospitals and medical doctors who are linked with a third-party administrator or insurer to provide health insurance at as discounted rate. Depending on your specific healthcare needs, a PPO may be able to provide you with specific healthcare options that may be more difficult to come by with other types of plans, such as HMOs.
Learn more about PPO health plan options
The Advantages of PPO Health Plans
One key benefit PPO health plans is that you have the option to choose your healthcare provider. This means that a PPO member does not have to seek care from a physician that is a part of the PPO network, as is the case for HMO plans. However, there is a financial incentive to choose a PPO physician.
If you were to choose a physician from within your PPO network, you may be reimbursed for up to 90% of the care, but only up to 50% for treatment provided by a non-PPO physician. To avoid paying an extra 30% of “out-of-pocket” expenses, many patients choose a PPO network physician.
Another advantage to PPO health insurance is that there is a limit to the amount of out-of-pocket costs that are paid. The usual out-of-pocket cost for an individual who receives care from a PPO provider is limited to $1,200 and $2,100 for a family. These out-of-pocket casts are significantly lower than that of many HMO plans.
If an individual or family chooses to be treated by a healthcare provider who is not within the network, these out-of-pocket costs are usually capped at around $2,000 to $3,500. When having PPO health insurance, it pays to use a network physician or healthcare provider.
The price that one pays for such particular benefits as a PPO can offer is that PPO plans typically have a higher co-payment then other health insurance plans, such as an HMO.
For many, the flexibility and low out-of-pocket costs that a PPO provides are perfect for their needs.
Find out about different plans available in your area to see which will suit you best