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Q: What Is a PPO?

Asked by Anonymous on October 12, 2017

Jeff Smedsrud October 12, 2017

A Preferred Provider Organization (PPO) is a type of health insurance plan where an insurance company makes arrangements with provider groups, care specialists, hospitals, and other sources of healthcare to form the plans network.

If you have a PPO plan, you can visit any provider in your plan’s network at a significantly discounted “in-network” rate.

More Choice & Flexibility

PPOs are attractive for many Americans, since these plans also cover medical costs outside of their provider networks. You generally don’t need a doctor’s referral from your primary care physician (PCP) to see medical specialists who are part of your PPO. PPO plans may let you choose a primary care provider, but you probably won’t have to do so.

If you visit a doctor, stay at a hospital, or use services that are part of the PPO, you will be considered to have used services that are in-network – therefore incurring no penalties for out-of-network providers. You can also see medical professionals outside of your PPO plan’s network. Your PPO may have an entirely separate deductible and out-of-pocket maximum for out-of-network medical professionals.

Higher Costs

Because of the greater flexibility afforded to policyholders, PPOs tend to be more expensive than an HMO. And even though you’re allowed to go out-of-network under a PPO, you’ll be responsible for a greater share the costs, which are likely to be higher than if you had stayed in-network.

PPOs are one of several types of common health plans – like HMO, EPO, and POS plans – that you may learn more about.

Taking the Next Steps

You can browse HealthCare.com with confidence, knowing that you understand the differences between insurance plans available in your area. Use our intelligent plan selection tool to choose an PPO if you prefer, or request a PPO on the phone from one of our affiliated brokers.

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