PPO Health Insurance

On the health insurance continuum, PPO health insurance plans lies somewhere between HMOs and pure fee-for-service plans. With PPO plans, your health care is managed (and so restricted), but you are granted a degree of choice regarding which providers you use. A PPO health insurance plan operates like an HMO in that you pay a fixed monthly premium, and, in return, the health insurance company and its health care network provide basic medical benefits to you.

However, a PPO differ from an HMO in that, under a PPO insurance plan, a primary care physician or "gatekeeper" physician is not required. As a result, seeing a specialist does not require a referral. But, If you need or want health care from outside the network, you should expect to pay a higher co-payment than if the provider were from within the PPO network.

Pros and Cons of PPO plans

Pros

• Health care costs are low when staying within the network.
• You can use any specialist, including ones outside the plan.
• Seeing a primary care physician is not a prerequisite.
• Out-of-pocket costs per year is limited.

Cons

• Paperwork is your responsibility if the care is non-network.
• Cost of treatment outside of network is more expensive.
• Co-pays are larger than with other managed care plans.
• You may need to satisfy a deductible.

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