A PPO plan lets you go to any doctor or healthcare provider as long as they participate in your health plan network. A PPO is sometimes called an Open Access Plan because it gives you direct access to a wide range of providers. This is unlike the Health Maintenance Organization (HMO), where the provider network is smaller, and you have to go to doctors and hospitals contracted with the insurer. If a provider and hospital are not contracted with your health plan, you will have to pay for the full cost of services yourself.
Here are reasons why a PPO plan stands out
A PPO plan will typically cost you less in premiums than other types of health insurance
The cost of a PPO plan depends on several factors, including your age and where you live. You can expect to pay more for this type of coverage than an HMO or high deductible plan because it offers more flexibility in choosing doctors and hospitals.
However, it won’t be as expensive as some other providers’ plans if you’re willing to go through the hassle of getting referrals from your primary care doctor before seeing specialists, which many people don’t find very convenient.
A PPO gives you the freedom to see any doctor without getting a referral first
A PPO gives you the freedom to see any doctor you want, regardless of whether or not they are in your plan’s network. If it’s important that your doctor is part of a well-rated hospital or has some special qualifications, this option might be right for you.
However, these plans may have higher premiums than HMOs because they offer more flexibility and choice. But if the extra money isn’t an issue for your budget, then this type of plan could work well for your family.
Your copay is usually lower when you see a doctor who is in your network
If you have a PPO plan, you pay a copay when visiting a doctor or other healthcare provider. A copay is an amount you pay before your insurance company starts paying for services.
Your in-network copay will be lower if the doctor or other healthcare provider accepts your insurance plan and is in the network of doctors covered by your plan. If they are not part of the network, they charge more money for their services because they don’t get paid as much by your insurance company.
You are protected from high medical costs
As you probably know, without health insurance, you are at risk of incurring high medical costs. You may be surprised to learn that out-of-pocket expenses can quickly add up to hundreds of thousands of dollars even in an average year.
For example, the average American will incur more than $5,000 in out-of-pocket medical expenses each year. That number could be even higher if you have a serious illness or accident that requires extended hospitalization and rehabilitation or surgery performed by a skilled surgeon who charges more than their peers.
PPOs give you access to all sorts of discounts that can help keep costs for preventive care and wellness services down while still providing quality care. These are services such as annual checkups, routine vaccinations, dental cleanings and other procedures that prevent the disease from developing before it starts
PPOs provide good coverage at a reasonable price
PPOs are also good for people who have complex medical needs since they provide more coverage than high-deductible plans. They tend to have lower premiums and copays than HMOs, and if you have a serious condition such as diabetes or heart disease, a PPO may be your best option. However, there are some drawbacks:
Who is Eligible for a PPO Plan?
The PPO plan has several different eligibility requirements set out by the various state health care regulators who oversee policies like this throughout the country. These requirements stipulate who can receive PPO coverage and how much they will be required to pay for it under the terms of their policy contract with the insurer. In most cases, individuals covered by a PPO plan have access to another form of insurance or work for large companies that self-insure all or part of their employees’ health care costs.
How to Choose a Good Healthcare Plan
When it comes to health care, you need more than just a good doctor. You need the right insurance. Whether you choose the Affordable Care Act or private insurance, many options are available to find the best plan for you and your family. Here are some tips to help you navigate the process of choosing a health care plan:
Know your needs: When looking for health care coverage, consider what is most important to you and your family. Do you need prescription drug coverage? Is dental care an important factor in your decision-making process? Do you have any preexisting conditions that require a specific type of insurance?
