PPO plans are Preferred Provider Organization plans. It is immensely popular amongst individual as well as family markets. Preferred provider organization allows us to visit whomever healthcare provider or physician we wish to visit. All this is done without the referral of a primary healthcare physician. PPOs encourage you to use the help of doctors, and you do not need to choose a primary care doctor. The insurance company does a wonderful job of forming a network of preferred healthcare professionals. This in-network healthcare service is covered with better benefits than out-of-network services. It does not matter who the health care provider is. However, it is important to check if your provider accepts your health plan. This helps you receive the topmost level of benefit coverage.
Difference Between PPO and HMO
Patients with an HMO always check with the primary healthcare physician first. The primary healthcare physician will refer you to an in-network specialist if they are unable to treat your problem. But a preferred provider organization plan allows you to see an in-network specialist without a referral. Nevertheless, there are exceptions for a few cases. These include emergencies, routine care, and an in-network visit to a gynecologist or obstetrician.
An HMO plan allows you to receive coverage only if you stay within your network of providers. However, a PPO plan allows you to check with other healthcare providers. Preferred provider organizations have a network of healthcare providers. But the patient is not restricted to seeing just those physicians. The patient is allowed to visit any health physician they want to visit.
The Working of a PPO
A PPO is an insurance-providing, managed-care network. It consists of various medical professionals and facilities. These include general physicians and specialist doctors, hospitals, and other healthcare professionals. These professionals’ bond with the insurance provider. By doing this they try and fetch to render subscribed participants. These are consumers getting coverage via the healthcare plan. They bargain fees and schedules for services. Also, this bargain rate is typically lower than their usual charges. With this, the consumers pay the preferred provider organization an amount as a fee to access the network of providers. Often the PPOs are sponsored by a particular insurance company or some other type of organization. The consumers either pay a co-payment during a regular check-up, or they must face a deductible before their insurance starts paying their claim.
PPO Insurance Cost
PPO plans offer maximum flexibility for their customers. Hence many people find their monthly premiums getting costlier day by day. The average cost of a monthly PPO is $517. This is 21 percent more expensive than an HMO policy. However, you should not disregard this option, even though a PPO is the costliest health insurance policy to buy. This is because it is useful for someone who has unique health needs. For example, somebody with a backache can meet a chiropractic specialist with the aid of a preferred provider organization.
Cons of PPO
As stated before, PPO plans are costlier than other health insurance options. PPOs have out-of-pocket costs, such as deductibles. Also, they have costlier monthly premium rates. Very frequently, you must pay for both insurance and co-pays. This is because preferred provider organizations are very flexible. Hence, they let you use providers both inside and outside the PPOs. You are free to do this without referrals. Also, the cost for coinsurance and deductibles is different for in-network and out-of-network providers. Therefore, keeping track of this bilateral system can get difficult and confusing. Also, some people find it difficult to manage and track their care without the interference of a primary care doctor.
Health Maintenance Organization
Somebody who requires secure health insurance finds various health insurance providers. Apart from PPO, another type of insurance provider popular in the health insurance marketplace is HMO. This is the Health Maintenance Organization. It is an insurance plan which gives coverage via a network of doctors and health professionals. HMOs, give health insurance coverage for an annual fee. It reduces member coverage to medical care provided through a network of healthcare professionals. These doctors are in a contract with the health member organization. These contracts lower down the cost of premiums. With this, healthcare professionals have the advantage of having patients directed by them. They are also capable of adding other restrictions to the health member organization members.
Choose Your Insurance Wisely
PPOs are called so because they have formed a network of providers. They prefer to operate within the network, but they also pay for out-of-network care. They are less restrictive than other plan types. Hence, they tend to have costlier monthly premiums with higher cost-sharing. Therefore, people are switching to EPOs and HMOs in recent times. Even though PPOs have lost some popularity, they are the common type of employer-sponsored health plan. This is because PPO plans have more detailed coverage. They include assorted services which other care programs leave out or charge an additional cost. Plans like these are more profitable in the non-individual insurance provider category. Also read: Advantages and Disadvantages of a Health Savings Account.