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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).
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.
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.
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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.
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.
There are several other healthcare plans available to meet your needs. Check out the links below for more information.
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 »
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 plans are similar to HMO plans but offer the increased flexibility of providing coverage for care costs outside of the network.Learn more »