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Insurance Type:

Preferred Provider Organization Plans (PPO Plans)

There is a reason why Preferred Provider Organization Plans (PPOs) are most popular among consumers looking for health insurance plans for themselves and their family. As with several other plan types, these plans are an arrangement between a managed care organization and a collection of doctors, hospitals, and other health care providers. The ultimate goal of this partnership is to provide medical care to patients at reduced rates.

These reduced rates are offered due to visiting a “preferred� provider. This is a great situation for all parties involved. As more people can offer healthcare, doctors and hospitals see an increase in the number patients they care for. Unlike HMOs, another very popular medical insurance option, PPO Plans are much more flexible regarding which physicians and care providers you can choose to see. When shopping for both individual and employer offered health benefits, you may use a non-network provider and luckily the rates are not as high.

In general, a PPO network is less restrictive than an HMO’s provider network. A PPO also does not require a Primary Care Physician (PCP) to act as a gatekeeper for specialists and other healthcare. If you need to see a specialist, you may make an appointment with an expert that you prefer, and without seeing your PCP for a referral.

Perhaps one of the major disadvantages of PPO Plans is the high deductible cost that is quite unappealing. This deductible is an amount set by the insurance company that you, the patient, must first spend out-of-pocket before the insurance company will begin to pay for some or all of your care. It is possible that, even after reaching the deductible, you will still pay a portion or percentage of your care costs.

PPO Plans offer flexibility at a cost, so it’s important to consider how important a wide range of choice is to you. These reduce rates are usually offered due to employers getting coverage for a large group. If you already have a Primary Care Physician with whom you have a good relationship, you may wish to choose a PPO especially if your physician is not in-network. If having access to specialized care is an important factor to you, a PPO is also a good option. Seeing a “preferred� provider will save you money but is not required as you are able to choose any physician or specialists and are generally not required to choose a Primary Care Physician.

Of the many health care plans available to individuals and employees, Preferred Provider Organization Plans are extremely popular due to the variety they offer. Co-pays are reasonable, most prescription drugs can be acquired at discounted rates, and a wide selection of network caregivers is available. You will pay more out of network but there are no penalties for it. Talk with your healthcare provider or with someone in control of your employer’s insurance benefits. They will be able to direct you in enrolling in this health care plan or assist you in customizing a plan that works for you. The freedom to choose what you want is definitely worth the extra expense when it comes to protecting you and your family’s health and wellness.

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