What is so Special about PPOs?

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