What is PPO Insurance?

What does PPO stand for?

PPO stands for "Preferred Provider Organization." It is a type of health insurance plan that features a large network of providers to choose from. This network includes doctors, hospitals, specialists, and other health care facilities. It's a flexible plan but comes with higher monthly costs.

How does a PPO plan work?

A PPO plan means that when you choose an in-network provider, you'll pay lower costs. You are still able to see a provider outside of the PPO network but you'll pay more out of pocket. In a PPO plan, it's not required to have a Primary Care Provider (PCP). You also don't need to have a referral to see a specialist.

PPO Plans for Individuals and Families

You can buy a PPO plan for yourself and your dependents through the Health Insurance Marketplace. Personal PPO health insurance coverage stays with you even if you change employers.

Employer-sponsored PPO Plans

If your employer offers health insurance coverage, you may be able to choose a PPO plan. With an employer-sponsored health insurance plan, employers will often cover a part of your health insurance premium each month.

What are the pros and cons of PPO?

A PPO plan may be the right fit for you, depending on your own health needs and budget. Let's take a look at the pros and cons of PPO.

Benefits of a PPO Plan

More Freedom for Selecting Providers

Some types of health insurance plans have limited networks. But with a PPO plan, you get a wide range of in-network providers. This means you likely have your choice of doctors and facilities to visit.

No PCP Needed

You don't have to work through a PCP in order to see specialists or get a referral.

Lower Costs for In-network Care

When you choose an in-network provider or hospital, you'll spend less on out-of-pocket costs. This includes co-pays and deductibles.

Covered Emergency Care

PPO plans typically include 24/7 emergency and urgent care coverage for eligible emergency situations. This includes out-of-network providers and facilities.

Disadvantages of a PPO Plan

Higher Monthly Premiums

PPO plans usually cost more each month. This is because you pay for the wide network of providers and the flexibility it offers.

Higher Out-of-Pocket Costs

Even if you choose an in-network provider, PPO plans are often more expensive than other health plans. You may have to meet an annual deductible before your plan shares medical costs.

Greater Responsibility for Selecting Providers

Depending on your preference, you may prefer your PCP to make referrals to specialists.

How do PPOs compare to other insurance plans?

PPOs share some of the same features as other types of health insurance plans. Here are some similarities and differences of PPO plans and other health plans.

What’s the difference between an HMO and a PPO health plan?

HMO stands for Health Maintenance Organization. Here is how HMO vs. PPO plans compare. In some cases, an HMO plan requires a PCP to coordinate care, while PPO plans do not require a PCP. HMO plans tend to have lower monthly premiums and out-of-pocket costs than PPO plans.

What’s the difference between an EPO and a PPO health plan?

EPO stands for Exclusive Provider Organization. Let's take a look at EPO vs. PPO plans. Neither EPO nor PPO plans require referrals to see specialists. Out-of-pocket costs and monthly premiums tend to be higher for PPO plans compared to EPO plans.

What’s the difference between a HDHP and a PPO health plan?

HDHP stands for High-Deductible Health Plan. HDHP vs. PPO plans are more difficult to compare. An HDHP is a category of health plan that offers lower monthly premiums than a PPO plan. You can also combine HDHPs with a health-savings account or HSA.

What’s the difference between a POS and a PPO health plan?

POS stands for Point of Service. Here's more about POS vs. PPO plans. POS plans typically don't have a deductible while PPO plans do. Both types of plans often require copays and/or coinsurance. Monthly premiums are usually more expensive with PPO plans compared to POS plans.

What is a PPO dental insurance plan?

Dental PPO plans are sometimes referred to as DPPO plans. Like health PPO plans, you can reduce your medical costs by choosing in-network dentists and other dental specialists. You also do not need to have a primary dentist to get a referral. While you can choose any dental provider you want with a DPPO plan, you will pay more when you go out of network.

DPPO plans usually cover the following services and procedures at no extra cost:

• Preventive care services, such as dental cleanings, oral exams, and X-rays
• Diagnostic dental services

DPPO plans may also cover part of the following services and procedures:

• Orthodontic services
• Dental fillings
• Root canals
• Tooth extractions
• Dental crowns
• Dental bridges
• Oral surgery