PPO plans, or "Preferred Provider Organization" plans, are one of the most popular types of plans in the Individual and family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.

 

How does a PPO plan work?

As a member of a PPO plan, you'll be encouraged to use the insurance company's network of preferred doctors and you usually won't need to choose a primary care physician. No matter which healthcare provider you choose, in-network healthcare services will be covered at a higher benefit level than out-of-network services. It's important to check if your provider accepts your health plan so you receive the highest level of benefit coverage.

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You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment of about $10 - $30 for certain services or be required to cover a certain percentage of the total charges for your medical bills.

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A PPO plan may be right for you if:

• You want the freedom to choose almost any medical facility or provider for your healthcare needs.

• You want a portion of out-of-network claims to be covered by your insurance company.

• You don't want to get referrals before visiting a specialist.