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PPO Health Insurance

What is a PPO plan?

A Preferred Provider Organization (PPO) plan is a type of healthcare plan that partners with a network of participating medical providers (i.e., physicians and hospitals).

How does PPO work?

When you need medical attention and have a PPO plan, you may choose to visit a doctor, hospital, or other healthcare facility that participates in your plan’s network in order to incur the least out-of-pocket expenses possible. However, if you choose to visit a provider that is out of your network, then you may be subject to a higher service fee and/or a separate deductible but you should still be covered by your insurance.

Are PPO plans expensive?

PPO premiums are generally higher than HMO or EPO plans, but this is because they offer more flexibility including no requirement to visit a Primary Care Provider to get referrals to specialist care. PPO plans also often require paying slightly higher out-of-pocket expenses, such as deductibles, copayments from doctor/hospital visits, and coinsurance than other plan types. PPO plans will cost you more if you choose providers outside of your network, so you can keep costs down by choosing providers that are in-network.

Am I eligible for a PPO plan?

The Open Enrollment Period for 2018 coverage is now open and runs from November 1st - December 15th. This means it's your time to sign up for an affordable Health Care plan. Don't miss your chance to enroll!

Why should I choose a PPO plan?

PPO plans are known for their flexibility in letting you choose who you want to receive care from.

You can choose the provider that you want to see, whether they’re in-network or not.

You aren’t required to select a primary care physician, which is often a requirement for other types of healthcare plans.

You may be able to see a participating specialist without a referral.

Why should I NOT choose a PPO plan?

Before choosing a PPO plan, there are several important things to consider:

If your preferred provider is not in your would-be network, then continuously visiting an out-of-network provider will result in higher expenses for you.

PPOs have expensive monthly premiums and high out-of-pocket costs. If you value your budget over flexibility then PPOs might not be the best choice.

Your PCP or other care providers may not accept PPO plans.

What are the alternatives to a PPO plan?

There are several other healthcare plans available to meet your needs. Check out the links below for more information.

HMO

Health Maintenance Organization (HMO)

Great choice for people who want to keep their premiums low, especially if you’re happy to see your PCP first when you need more specialized care.

Learn more »

EPO

Exclusive Provider Organization (EPO)

Great for people who are conscious of their budget as they often offer lower premiums and cost sharing than PPOs. However, there’s no coverage for out of network care.

Learn more »

POS

Point of Service (POS)

POS plans are similar to HMO plans but offer the increased flexibility of providing coverage for care costs outside of the network.

Learn more »

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