What is a PPO?
Picking a health plan can be tricky enough without deciphering acronyms. If you’re not sure what to make of a PPO versus an HMO or any of the other things you may come across while shopping for a plan, know it’s all simpler than it may seem.
A PPO, or Preferred Provider Organization, refers to a health insurance plan that allows its members to have greater flexibility in choosing their doctors. It has an established network of providers who contract with that specific health plan, and these health care providers are known as being in-network. PPO members are able to see in-network providers for far less than they can see those who are out-of-network. Unlike an HMO (Health Maintenance Organization), a PPO will still partially cover costs associated with out-of-network care, but you’ll pay more than you would with in-network care. A PPO network of doctors is typically larger than an HMO network, but you’ll have to check with the insurance company offering the plan to see the size difference.
You can see health plans and prices by entering your zip code below.
How does a PPO provider network work?
A PPO provider network is typically quite big, giving those who select these kinds of health plans the most flexibility in terms of accessing care. But because these plans provide some coverage for out-of-network providers, even if you see someone who is not contracted with your health plan — or need to see a doctor while traveling out-of-state — you’ll still have some coverage for this care.
Do you need a Primary Care Physician to use a PPO?
There is no mandatory Primary Care Physician for a PPO plan.
Like with any health plan, it’s great to have an internal medicine doctor or general practitioner. That way, you can have an annual physical exam, which is covered with a $0 copay thanks to the Affordable Care Act. And this kind of preventative care is key to helping keep yourself healthy — and keeping your health care costs low.
Do you need referrals for specialists on a PPO?
You do not need referrals to see specialists on a PPO health plan. If there is specialist care you believe you need, you may schedule appointments at your own discretion, without first going through a PCP or any other provider.
Because of the nature of PPO health coverage, you can even see specialists that are out-of-network, though your copayment and other costs will still be higher for that care than if you opt for an in-network provider.
How do PPOs differ from HMOs?
You can check out our informative video on HMOs vs PPOs from our co-founder, Cat Perez.
HMO plans tend to have lower premiums than PPO plans, but PPO plans give you access to a larger network of doctors. HMOs typically don’t cover out-of-network medical care, whereas PPOs cover out-of-network care, although at a lower rate than they cover in-network care. If you plan on seeing out-of-network providers, your out-of-pocket costs may be lower with a PPO. But if you plan on staying in-network, an HMO may have lower premiums. You can search here to see plans and prices and find the most affordable option for you.
What are all of my health insurance options?
- Marketplace/Obamacare plan. You can enroll in a Marketplace health insurance plan, also known as Obamacare or Affordable Care Act insurance. See plans and prices here.
- Medicaid. You also may be eligible for Medicaid, depending on your income. You can see if you’re eligible and apply here.
- COBRA. If you’ve been laid off recently, you usually have the option of COBRA, where you pay the full premium of the same insurance your employer purchased for you. COBRA is typically much more expensive than Marketplace insurance, but it allows you to continue the coverage you already had. Learn more about comparing COBRA with Obamacare health insurance.
- Medicare. Once you turn 65, you’re eligible for Medicare. Call us to enroll at (855) 677-3060.