What is a PPO Plan?
PPO represents Preferred Provider Organization. Similar to HMO, a PPO plan provides a network of health care providers that you can utilize for your health care treatment. These insurers have decided to offer care to the plan members at a specific rate. This involves physicians, experts, urgent care treatment centers, hospitals and drug stores. All you need may be at your fingertips in-network, but with a PPO, you may enjoy more freedom to choose your own physician than you might have with other kinds of health insurance plans (such as HMO plans).
What to Expect
Even though you may want affordable PPO insurance, you want to have the perfect expectations choosing. Initially, PPO plans seem to have higher premiums, and it’s very likely that there will be a deductible and copay. Though the potential to use out-of-network services still exists, the cost-sharing is higher than using in-network physicians and clinics. Also, there are no two PPO plans that are the same. Every plan has a very distinct out-of-network insurance coverage. There are some PPO plans that have high cost-sharing for specific out-of-network services and others that do not.
That’s why you want to watch each plan’s cost-sharing (the premium, deductible, copay, coinsurance, and out-of-pocket maximum) amounts. You also want to get a personal catalog of you and your family’s needs. For example, if you have a healthcare need that demands a close watch and wants the flexibility to select nearly any consultant or health service without requiring a recommendation, a PPO is a wise decision for you. This is particularly true if you want no less than a part of those out-of-network claims covered by your insurance plan. However, if your bigger concern is more affordable monthly premiums, an HMO could be the more sensible choice.
How Does a PPO Plan Work?
As a member of a PPO plan, you’ll be motivated to use the insurance provider’s network of preferred physicians and you normally won’t need to select a primary care doctor. No matter which medical care provider you select, in-network healthcare services will be covered at a higher benefit level than out-of-network services. It’s crucial to examine your company allows your healthcare plan so you can get the highest level of benefit coverage.
You will most likely have a yearly deductible to pay before the provider starts covering your hospital bills. You may also have a co-payment of about $10-$30 for specific services or be expected to cover a specific portion of the overall expenses for your hospital bills.
A PPO plan may be perfect for you if:
- You want the flexibility to select practically any medical service or company for your health care needs
- You want a part of out-of-network claims to be covered by your insurer
- You don’t want to get referrals before going to a consultant
- The key to locating the suitable plan for you is to reach a balance between the insurance coverage you want and the premium you can manage to pay for.
A Little Bit Confused?
Receiving guidance from a person who can offer impartial advice on these plans, like a Health Coverage Fast agent, will put you at a lesser risk.