PPO stands for preferred provider organization. Just like an HMO, or health maintenance organization, a PPO plan offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate.
But there are some differences. Let’s go over the key things to consider when deciding if a PPO plan is right for you.
Unlike an HMO, a PPO offers you the freedom to receive care from any provider—in or out of your network. This means you can see any doctor or specialist, or use any hospital.
In addition, PPO plans do not require you to choose a primary care physician (PCP) and do not require referrals. For example, if you already have a doctor you like, you can continue receiving care from that provider.
If you need to see a specialist, you do not have to first consult with a PCP. No referrals are required for any doctor, specialist or hospital.
Another bonus: If you find yourself in need of medical care when you are away from home, you can see any healthcare provider you choose.
A PPO health insurance plan provides more choices when it comes to your healthcare, but there will also be higher out-of-pocket costs associated with these plans.
Your monthly premiums will be higher and your copays for office visits will also cost more. Plus, there is also an annual deductible that must be met.
To help reduce costs, remember that using in-network providers, doctors and other healthcare professionals who are a part of your PPO network will save you money.
If you are eligible to enroll in Medicare, there are Medicare Advantage PPO plans available. Get the details on Humana’s Medicare Advantage plans.
A PPO is generally a good option if you want more control over your choices and don’t mind paying more for that ability. It would be especially helpful if you travel a lot, since you would not need to see a primary care physician.
The key to finding the right plan for you is to strike a balance between the coverage you want and the premium you can afford.
For more help deciding if a PPO or an HMO is right for you, see our HMO vs. PPO comparison chart
If you’d like some help figuring out how to manage your healthcare costs, we can help.