PPO - Preferred Provider Organization

WHAT IS A PPO PLAN?

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.

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.

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.

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