A PPO, or Preferred Provider Organization, is a collection of hospitals and medical doctors who are linked with a third-party administrator or insurer to provide health insurance at as discounted rate. Depending on your specific healthcare needs, a PPO may be able to provide you with specific healthcare options that may be more difficult to come by with other types of plans, such as HMOs.

PPOs lie between HMOs and pure fee-for-service plans. Your health care is managed but the client is granted a degree of choice in providers. You still pay a monthly premium and in return the network provides PPO insurance service to the client.

The main advantage of the PPO system is that no gateway or primary care physician is required for referrals.

Through our search, 1000’s of PPO health insurance plans are archived for the lowest rates available.

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PPO is short for Preferred Provider Organization. PPO health insurance plans are based on contractual relationships that the insurance companies have with the organizations. The term “organizations” refers to the healthcare providers, doctors, hospital, clinics, etc.

Thus, PPO plans have pre-approved lists of healthcare providers called the Participating (In-Network) Provider list. But they also allow you to see healthcare providers who are not on the list called the Non-Participating (Out-of-Network) Provider list.

Benefits to a PPO are the fact that its premium is less costly than that of an individual health insurance plan and the reality that PPO networks typically have a plan that will proffer recommendation drugs at much lower prices. A PPO will cover more medicinal services than an individual health insurance plan as well.

Note that when you use a non-participating provider you will end up paying more than if you had used one in-network.

Pros:

• Access: You have access to a larger number of doctors and facilities.
• Choice: You can chose whatever doctor you want to see for your healthcare needs.
• Specialists: you do not have to have a referral to a specialist.
• Primary Care Physician: You do not have to chose and be tied to a primary care physician.
• Negotiated Fees: When you use a participating provider, the amount charged will be a negotiated amount less than the provider would charge someone without the plan.

Cons:

• Deductible: There is almost always a deductible to be met.
• Co-Insurance: After the deductible is met, there is a co-insurance amount that you are responsible for paying the average being 30% of the cost.
• Out of Pocket Expenses: Overall, PPO plans cost you more between the deductible and co-insurance and other out-of-pocket expenses.

In the end it comes down to what is important to you. Are you willing to pay extra for open access to the healthcare provider of your choice?

What Are the Advantages?

• Your PPO Plan will limit your annual out-of-pocket costs
• You’ll be free to consult any medical specialist you’d like to, including those outside your PPO Network
• Your overall healthcare costs will be low whenever you use the PPO network’s doctors and hospitals

And The Disadvantages?

• You’ll need to meet a deductible before coverage kicks in
• If you seek treatment outside of your PPO Network, it will be more expensive
• Your PPO’s co-payment rates will generally be greater than those of other managed care plans

How to Find Affordable HMO Health Insurance and Pro and Cons of HMO and PPO Health Care Plans

Start by contacting your State Insurance Commissioner’s office. The Insurance Commissioner’s office should be able to provide information about health insurance programs that are available in your state, including affordable HMO health insurance.

Do a Web search using the term affordable hmo. If you want to compare affordable HMO health insurance options available by state, check out AARP’s HMO Report Card.

Faced with ever-increasing medical costs, selecting the best health plan for you and your family requires informed decision-making on your part. There are two basic forms of employer sponsored health plans: HMO & PPO. Compounding the problem, individuals without a health insurance plan, even after diagnosis, receive less treatment. Studies also show that individuals without a medical plan are hospitalized 30-50% more often for avoidable conditions.

Managed Health Care Benefits

Managed health plans reduce medical costs to enrollees, allowing them to receive medical care that they might not otherwise be able to afford without a medical plan. Health insurance companies develop contracts with health care providers, promising to provide specific doctors and hospitals with more business through their health insurance. HMOs and PPOs are both managed medical plans that reduce the cost of medical treatment by combining contributions of enrollees and gaining the benefits of scale.

There are other medical plan mechanisms put into place to reduce medical costs by encouraging such incentives as preventative care, enforcing limitations to coverage and increased beneficiary cost sharing. There are significant price, service, and flexibility differences between these two types of medical plans. Whichever medical plan you select, you will be able to receive more medical care for far less money than if you had no insurance at all.

HMOs, or Health Maintenance Organizations, are health plans characterized as cooperatives of doctors, hospitals, and other medical providers. HMOs such as Kaiser Permanente and Aetna are your least expensive and most restrictive health plan. Under HMO policies, health insurance providers have agreed to provide their services at fixed prices and copayments are generally very low. HMOs focus primarily upon preventative services such as immunizations and physicals. HMO doctors are paid on a per office visit basis.

PPOs, or Preferred Provider Organizations, are health care plans that have contracts with insurance companies to reduce medical expenses to enrollees. Enrolling in a PPO provides you with more control over your health care plan as well as greater autonomy. Unlike HMOs, emergency room visits are generally covered under PPO medical plans. One aspect of a managed health care plan is that treatments are reviewed by the insurer. Eat right, stay fit, and enroll in a health care plan!

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