PPO Plan Options and Flexibility

Preferred Provider Organizations are typically seen as the most flexible of health care options because they allow subscribers to choose their physicians from a wide network, see specialists without getting a referral or waiting around, and receive a comprehensive set of benefits for a reasonable cost.  Though they are more expensive than HMOs (otherwise known as Health Maintenance Organizations), they are usually able to provide better, faster care and more numerous options for both preventing and treating illnesses and injuries as they arise. 

PPOs do not require participants to choose a primary care doctor up front.  Instead, you can make an appointment with any medical professional in the network at any time.  This flexibility can be especially important if you have a difficulty finding doctors that with whom you connect, and it can be critical if you have children, who really need to feel comfortable with their physicians. 

Another key difference between PPO plans and HMO plans is that in almost all cases, subscribers of the former type do not need to worry about referrals when they feel the need to see a specialist like an obstetrician, oncologist, endocrinologist, orthopedist, or other professional.  Waiting for primary care physicians to give referrals is one big complaint that most people have about Health Maintenance Organizations – when you are worried or needing treatment for a medical problem, the last thing you want to do is extend your wait for quality care.  You also risk being denied the opportunity to participate in things like clinical trials and experimental care options, limiting the types of solutions you can seek for any given problem. 

It is imperative to note that even with the flexible options offered by this type of medical insurance, you may sometimes decide to seek care out-of-network.  Expect this to be somewhat rare, but do be prepared to pay higher fees if and when you choose a non-participating doctor to treat you.  You will still be reimbursed for much of the expense by your insurance provider, but staying in-network is highly recommended.

Because these plans are significantly more expensive than HMOs, they are not for everyone.  However, there are ways to reduce your premiums, particularly by increasing your deductible (if you can afford to do so), and potentially by raising your co-payments as well.  Co-payments are those made at the time you visit a physician; usually they range from $10-$50 but they can be more. As with deductibles, the more of the cost you take upon yourself, the better your PPO rates will be. 

Finally, don't underestimate the importance of using every reasonable option you have to maintain or improve your health.  Quit smoking (or better yet, don't start!), take care to adhere to a healthy diet and exercise routine to keep your body active, and see your doctor regularly – because check-ups and well-visits are covered! 

If you are trying to decide between Preferred Provider coverage and HMO policies, take a few moments to request a quote, and one of our knowledgeable representatives will be able to help you compare your options to make the smartest decision for your physical – and financial – well-being.