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PPO - Preferred Provider Organization

PPO health insurance plans are very similar to HMO plans. These types of medical insurance plans provide health care for their members by contracting with selected hospitals and doctors, much like an HMO. However, unlike an HMO, many PPO programs will cover non-network providers if you pay a larger co-payment or deductible.

Under a PPO insurance plan, a primary care physician or "gatekeeper" physician is not required. As a result, seeing a specialist does not require a referral. But, If you need or want health care from outside the network, you should expect to pay a higher co-payment than if the provider were from within the PPO network.

PPO health insurance plans are good for people who want a percentage of autonomy in their health care. If you have health problems and like to try different doctors or get several opinions, a PPO will probably work better for you than an HMO. It will cost you more money, but you get more freedom to make your own health care decisions.

PROS

  • Relatively inexpensive if you stay in network for your care although more than an HMO plan
  • You can use specialists outside network assuming you accept the additional costs
  • No need to receive a referral from your Primary Care Physician to see a specialist

CONS

  • Paperwork is your responsibility if the care is non-network.
  • Cost of treatment outside of network is more expensive.
  • Co-pays are larger than with other managed care plans.
  • You may need to satisfy a deductible.

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