What is a PPO
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What Is a PPO?

PPO stands for preferred provider organization. It is a kind of health insurance.

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PPO basics

In a PPO you get most of your health care from a network of providers, just as you do in an HMO. But you can choose to go outside of the network and pay more.

Primary care doctor:You can have a primary care doctor in a PPO, and it is often advisable to have one, but you do not have to. You can go to a specialist and get other services without first seeing a primary care doctor and getting a referral.

Networks and medical groups:Like HMOs, PPOs have a network of doctors and other providers. However, you can choose to see providers who are not in the network. You usually pay a higher cost to see providers who are not in the network.

 

Why would I choose a PPO?

  • You have a doctor you like and you want to keep this doctor.
  • You want to see specialists and other providers without having to get referrals and pre-approval first.
  • You want more of a choice of doctors and hospitals you can go to.
  • You want the freedom to see providers who are not in the network.
  • You are confident that you can manage your own care.
  • You do not want a primary care doctor.

 

Why would I NOT choose a PPO?

  • You don’t want the extra responsibility of managing your own care.
  • PPOs are not as closely regulated by the government as HMOs.
  • You do not want to pay the higher costs of a PPO.
  • You do not want to get bills from providers.

 

More about PPOs

The providers in the network have an agreement with your PPO that sets a price to provide you a service, like an office visit or surgery. These providers cannot charge you more than the set price. But a provider that is not a part of the network can charge you more. Learn more about PPO costs...