PPO Health Plans

With so many different options for health insurance available in the market today, it’s tough to avoid becoming confused and frustrated when trying to decide which type of insurance will be best for your situation. For many individuals, purchasing health insurance from a Preferred Provider Organization makes the best sense, and can provide cost savings when compared to traditional health insurance providers. Let’s take a look at PPOs and how they work.

Preferred Provider Organizations are a unique type of group health insurance plan that offers a network of fully-covered treatment providers alongside the flexibility to use your own doctor, dentist or other professional for your health care. The costs involved with using an “in-network” treatment option are generally lower than going outside, which is the main incentive that a PPO offers. Virtually anyone can sign up with a PPO for their health insurance, although they are mainly offered through the workplace or as a benefit for being a member of an organization.

The key benefit with a PPO is the ability to bring along your own existing relationship with health care professionals that you are comfortable with when you join your PPO. Even though these doctors are outside the PPOs network, the PPO will still cover some of the costs associated with using them. PPOs are also an excellent option for those who demand a high level of care when they are sick or injured. Before you sign up with a PPO, it’s possible to see which local hospitals and other treatment facilities are part of their network, so you can decide for yourself if the treatment options are of the caliber that you’d prefer to use.

Another big benefit that comes with PPOs is that typically a referral to a specialist won’t be required. With HMOs and other health insurance options, referrals from a primary care doctor are required before specialist fees will be covered. With many PPOs this requirement is removed, and you can see an in-network or out-of-network specialist and have your costs covered accordingly.

There are some disadvantages that come with using a PPO as your primary health insurance provider. While all PPOs allow their customers to use health care providers that aren’t part of their network, they may not cover 100% of the costs involved in doing so. This means that even though you have health insurance through your PPO, if you go to a doctor outside of the network for treatment you may only get 70% of your treatment cost covered which leaves you paying out of pocket. Also, PPOs sometimes require co-payments for other features that they support, such as preventive care. While it’s in a health insurance company’s best interests to have their clients in the best health possible, they aren’t all willing to make the investment required in preventive care without the client kicking in some as well.

Of course, as with many other types of health insurance there is almost always a deductible amount that will have to be paid when using either in or out-of-network health care providers, so this is another disadvantage worth noting. Less expensive options such as HMOs may not have a deductible amount for treatment.

In terms of total overall costs, going with a PPO will likely not be an individual’s cheapest option but generally they are very competitive with the other offerings on the market. HMOs are usually less expensive, but don’t have the flexibility of being able to use your own out-of-network health care provider for certain treatments. PPOs are very popular with small business owners because of the high level of benefits and flexibility offered at a decent cost.

Going with a PPO for your primary health insurance needs is an excellent option that is likely to meet most of your needs without a high level of additional costs. While some copayments may be required, it’s likely that your PPO will take care of you and if you ever decide that you don’t want to pay the additional cost to use your own doctor you can always opt for a fully covered doctor inside the PPO’s network.

Self Health Insurance has made finding the best prices for local PPOs and other health insurance plans quick and easy. Simply scroll up to the top of this page and enter your ZIP code in the “Get Quotes” box to receive free price quotes for your health insurance.

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  1. [...] Preferred Provider Organizations or “PPOs” offer the cost savings of having a network of approved providers with the flexibility to choose out-of-network care if you so choose. The upside to this is that you can go ahead and seek a second opinion, use preferred doctor or see a specialist without a referral from your primary care doctor. The downside to PPOs is that taking advantage of these options is generally a costly affair, and the deductible and copayment amounts of using out-of-network care can add up very fast. Many PPOs also have co-insurance fees that need to be paid after deductibles are exceeded. [...]

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