A PPO plan allows you to visit a hospital or doctor in the network. The plan is more expensive than an HMO and you will have higher out-of-pocket expenses. Your needs and budget will determine if a PPO is right. A PPO can offer many benefits.
Flexibleness is one of the best benefits of a PPO program. Providers can be found in nearly every state and city. This means that you can easily find the best doctors or medical care in your area. And since the PPO network incentivizes in-network care, you may pay less out-of-pocket for the services you need.
Another advantage of a PPO plan is the possibility to choose your own primary physician. Some cases will not require you to get a referral form your PCP in order for you to see a specialist. You will need to refer a specialist if you don't have a PCP referral. However, you will pay more if you see a specialist with a referral. For certain healthcare services, you might have to pay a copay or a fixed dollar amount.
You might be able to avoid this cost by calling the insurance company before you receive care from an out-of-network provider. You can avoid having your claim denied by calling the insurance company.
A PPO allows you to use any provider within the network. This gives you the freedom to choose the doctor you want. You will still be responsible for all care received outside the network. Although insurance companies and physicians often agree to lower the usual rates for their services, you could still end up paying more if they choose to refer you to an out of network provider.
A PPO offers another benefit: Your doctor and any other medical professionals can negotiate with health facilities about fees and schedules. If you have a PPO, you'll have more options for lab and testing locations. This means you can get the care that you need, regardless of whether you are at home or abroad.
Some other factors to consider when choosing a PPO are deductibles, copays, and coinsurance. Deductibles are the amount you have each year to pay before your insurance coverage kicks into effect. The first $1,000 of your costs is usually covered. After this amount, your insurance company will cover the rest. Each time you visit a provider, you will be charged a copay. Depending on your plan and other factors, you might have to pay for tonsillectomies (or birth control). You can also pay for medication you purchase at the pharmacy. Your insurance company will be able to tell you what types of prescriptions they cover.
PPO health insurance policies are an excellent choice for those who self-manage their medical care. People who frequently travel and want to have the option of seeing any healthcare provider can opt for this type of insurance. Ultimately, the health insurance plan that's right for you depends on your needs, your budget, and your lifestyle.