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What Is a PPO?

As you shop for health insurance, you’ll have to navigate through an alphabet soup of acronyms like HMO, EPO, PPO and POS. The key to getting the best kind of healthcare coverage for you and your loved ones is knowing what your options are. For starters, it helps to understand how PPO plans work and how they compare to other types of insurance plans.

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How PPO Health Plans Work

PPO stands for preferred provider organization. If you apply for a PPO health plan, you’re not required to follow any strict guidelines when it comes to receiving medical care. For example, you don’t need to choose a primary care physician (PCP) who you’ll visit regularly.

Under a PPO health plan, you’ll have a network of healthcare providers who participate in your plan. But you can technically see any doctor regardless of whether they’re in your network. That means you would have access to more healthcare professionals than you would under a standard HMO health plan.

The Perks of Having a PPO Health Plan

What Is a PPO?

PPO plans are generally more flexible than HMO (health management organization) plans are. If you want to see a physician or visit a hospital that you found on the internet, you won’t need a referral from a PCP. And if the doctor you’ve been seeing for years is suddenly no longer part of your network, you can continue to visit him or her anyway if you have a PPO plan.

Since you’re not obligated to visit the specialists or medical facilities within your network, it’ll be easy to find a doctor if you need one while you’re traveling outside of the country or visiting another state. Your PPO health plan can pay for your medical services even if you’re outside of your network. In contrast, people with HMO plans must see the providers and specialists within their network in order for their insurance to pay for their medical care (unless there’s a dire emergency).

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The Drawbacks of Having a PPO Plan

The downside to having a PPO is that these plans generally cost more than HMO plans. You’ll pay a higher insurance premium every month. And in many cases, you’ll be required to pay a deductible before your healthcare coverage kicks in. You may have to pay for other costs as well, like copays or coinsurance.

Your out-of-pocket expenses could also be higher if you have a PPO plan instead of an HMO plan. Whenever you visit a specialist or hospital outside of your network, you’ll pay more out of pocket than you would if you only used the providers within your network.

Depending on the doctor you see, you may have to pay for your medical care upfront and file a claim later asking your insurer to cover their share of your medical costs. This tends to happen when you venture outside of your network of healthcare professionals. But if your health insurance claim is denied, you may not receive any sort of reimbursement for the healthcare expenses you paid out of pocket.

Having to pay for healthcare without the help of insurance could be financially devastating, particularly if you haven’t made room in your budget for an emergency fund.

Should You Apply for a PPO Plan?

What Is a PPO?

To answer that question, you’ll need to think about your healthcare needs, your lifestyle and your financial situation. If your job forces you to travel a lot or you enjoy vacationing in different places throughout the year, having a PPO plan could come in handy (especially if you’re injury-prone or you get sick often). You’ll have more freedom when it comes to choosing healthcare providers and hospitals. And if that’s more important to you than the cost of your medical care, you may not mind paying more out of pocket under a PPO plan.

On the other hand, having a PPO plan could wreak havoc on your finances. If you’re trying to save money for a major purchase or retirement, you might be better off with a low-cost health plan like an HMO plan.

Related Article: How to Pick a Health Insurance Plan

Final Word

PPO plans offer more flexibility than HMO plans. But in exchange for this benefit, you’ll likely pay more for your health insurance. To avoid letting healthcare costs bust your budget, it’s a good idea to shop around and look for PPO plans with lower premiums. Going with an in-network doctor or medical facility over an out-of-network provider can also help you save money.

Photo credit: ©iStock.com/asiseeit, ©iStock.com/asiseeit, ©iStock.com/monkeybusinessimages

Amanda Dixon Amanda Dixon is a personal finance writer and editor with an expertise in taxes and banking. She studied journalism and sociology at the University of Georgia. Her work has been featured in Business Insider, AOL, Bankrate, The Huffington Post, Fox Business News, Mashable and CBS News. Born and raised in metro Atlanta, Amanda currently lives in Brooklyn.
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