What Is A PPO Health Insurance Plan?
You may have heard the term PPO & HMO, maybe even nodded your head in conversation and acted as if you know precisely what a PPO is. You may know it's popular and realize it's better than an HMO. But when it comes to many of these different insurance terms, it leaves you scratching your head.
With all the different insurance terms, such as PPO, HMO, EPO, Deductibles, Max out of Pocket, Coinsurance, etc. Were going to focus on what is PPO Health Insurance in health insurance? The acronym PPO stands for Preferred Provider Organization and is one of the most popular types of coverage. PPO health insurance plans contract a network of medical providers, doctors, and facilities agreeing to charge a set rate for their services. By staying in-network, members will enjoy significant savings on all healthcare-related costs compared to seeking medical attention outside the network.
One of the most popular features of a PPO plan is its flexibility. While most health insurance plans, like HMOs, require you to select a Primary Care Physician, Preferred Provider Organizations don't. You also won't need a referral to see specialists. You even have the flexibility to go outside of the plan's network if need be.
How Preferred Provider Organizations Work
Now that you know what PPO means, let's take a closer look at this type of coverage. We briefly touched on how Preferred Provider Organizations use provider networks, but how does that save you money? Well, it boils down to this simple idea. Health insurance companies and medical providers are in the business of making money. While health insurance providers have an extensive list of members, medical providers have the skills and experience to look after the health and wellbeing of those members. They arrange a contract to provide care to the insurer's members for a predetermined contracted rate. By doing so, health insurance companies will save money by cutting costs, and medical providers will receive more business as preferred providers. The arrangement is typically a win-win situation for both parties and, most importantly, benefits you.
What's Covered?
Suppose you're purchasing a PPO insurance plan through the Marketplace. In that case, it will need to cover the minimum essential benefits mandated by the Affordable Care Act (Obamacare). On the other hand, suppose you opt to purchase health coverage outside the marketplace. In that case, your coverage will largely depend on your plan and who the insurance provider is. Although, most PPO plans provide extensive coverage as they have contracts with a large provider network at lower rates.
Flexibility
With PPOs, you don't need to choose a Primary Care Physician (PCP). Instead, you choose which doctors you want to see and how often you wish to see them. Here are three examples of why flexibility in seeking medical care can be helpful:
If you need to see a specialist, you can make an appointment without getting a referral from your primary doctor prior. Ideally, this saves you time and one less co-pay you have.
If you visit a doctor you don't like. You can make your next appointment with a different in-network doctor. No questions asked, and no waiting for approval from your insurance provider to switch doctors.
If you don't want to see a doctor for routine check-ups, you don't have to. You have the freedom to seek care whenever you want and from any doctor in your PPO network.
How Much Does A PPO Cost?
There are a few factors that determine the cost, such as age, how many people are insured, and zip code. Each plan also can differ in network size, copays, deductibles, and Max out of Pocket, which are all factored into rates. PPO plans on the marketplace are harder to come by. A large portion of country PPOs are not even available on the marketplace. If in the event they are, we generally see them much more expenses than HMO & EPO networks. Private PPO plans are available in most areas. These plans are short-term medical plans, which, although usually a PPO, provide limited benefits. Always speak to a Licensed Advisor before enrolling in any plan, especially short-term plans. Also, there are private plans that are subjected to a medical risk assessment, which typically results in more affordability bc the risk pool is healthier for individuals who have a smaller claims history. The insurance company can offer lower rates, PPO networks, and more benefits.
Where To Start Your Search
If you want to learn more about PPO health plans and whether or not it's your best coverage option, the best place to start is right here. RKA Insurance Advisors has helped thousands of individuals and families find the best policy by taking an educational approach and reviewing ALL the options available in your area. Getting started is as simple as going to our appointment page. Scheduling a time and day, you would have a few moments and speaking to one of our Licensed Advisors. We are here if it’s even to get a second opinion on your current plan. We look forward to hearing from you!
www.RKAinsuranceadvisors.com
561-806-9913
Robert@RKAinsuranceadvisors.com
