Everything You Need to Know About PPO Insurance

If you are looking for one of the most flexible health insurance products for individual or family coverage, then PPO insurance is going to be one of the best options that you find on the market.

This type of insurance offers more freedom when you choose health providers, and it is also relatively affordable, making it perfect if you are shopping for insurance on a budget.

The following is all you need to know about PPO insurance, including how it works, how you will choose your service providers, and how to determine whether it’s the right insurance for you.

How Does PPO Insurance Work?

PPO Insurance, otherwise known as Preferred Provider Organization Insurance, is a type of insurance product where you will have the freedom to choose your doctors for both primary care and specialty care. With most policies, you can receive insurance anywhere in the United States, and your insurance could even cover you when you are traveling overseas in some circumstances.

Being a preferred provider plan, the biggest savings come when you choose service providers from within the insurance network, however, PPO insurance can still offer coverage when you are outside of the network, although the out of pocket costs will be higher.

When you sign up for a PPO healthcare plan you will be provided with a complete list of practitioners and medical facilities that are members of the network. This will allow you to choose the service providers in your area that can offer health care at the lowest out of pocket cost. Because you will receive more affordable healthcare from within the network, it is recommended that you choose the listed doctors and specialists whenever it is convenient.

Primary Care Physicians and Referrals with PPO Insurance

PPO InsuranceBeing able to get some level of coverage both inside and outside of the network is one of the biggest advantages of choosing PPO health insurance. Another advantage is the fact that you can choose doctors and specialists that you want to visit. This is significantly different from both exclusive provider and HMO insurance options.

An HMO plan would require that all your medical services begin with a primary care physician (PCP). Based on consultation, this physician would then determine whether you require a referral to a specialist or another clinic. If the PCP doesn’t provide that referral, then you would have to shoulder the full cost of any treatment that you receive.

With PPO health insurance, you can always choose the doctors and specialists from within the network. This means that if you want a certain procedure done, or if you want to consult with a specialist, then you will have coverage from your insurance.

This is convenient in many different scenarios, particularly if you are aware of your own health conditions and you know that you need to see a specialist such as a gastroenterologist, or an allergist etc.

If you have looked at other types of insurance and have found them to be too rigid in what they provide, then a PPO insurance plan could be perfect for you.

Cost of PPO Health Insurance

The cost of PPO insurance will depend on the insurer that you choose and the number of people that you are insuring. The level of care and the amount of coverage provided will also have an influence on the total cost of your insurance.

Typically, PPO insurance plans will have higher monthly premiums with lower deductibles. This can be especially helpful if you visit specialists often. Out of network services will attract less insurance coverage, so this is something that you always need to keep in mind.

With this type of health care plan, you are paying for freedom and flexibility. If you travel often, if you know that you will require multiple consultations throughout the year, or if you have children in the family, then having the freedom of a PPO insurance plan will offer you more peace of mind.

Out of Network Care When You are Covered by PPO Insurance

Emergency medical care is covered by all ACA compliant insurance products, regardless of the exact type. This is true for PPO Insurance, even if care is provided outside of the preferred network.

Non-emergency medical services will be covered, although the co-payment will be higher and there will be a unique deductible for out of network care.

Again, it is highly recommended that you visit with doctors and specialists within your network. In circumstances when this is not possible, you can at least take comfort knowing that you will be offered some level of financial coverage from your insurer.

The exact amount of coverage and the specifics of co-payments and deductibles change from insurer to insurer, and from plan to plan. Make sure that you always compare your options in detail so that you know you are getting the best deal for your needs.

Determining Whether PPO Insurance is Right for Your Needs

There are some simple things to consider that can help you to determine whether a PPO plan is right for you.

  • If you don’t typically require specialist care throughout the year, and you and your family are in good health, then you could save money by going for an HMO plan. While these are less flexible, they are better suited to those who only need occasional or emergency medical care.
  • If you require regular consultations and treatments and have a history of high insurance utilization, then a PPO plan would be ideal. The higher premiums are offset by lower out of pocket costs. The more treatments you receive in a calendar year, the higher your savings will be.
  • If you already have a history with a specific service provider, then a PPO insurance plan can give you the freedom to keep seeing that provider, even if they are out of network.

Compare the Best PPO Health Insurance Plans for 2019 with Mutual Health Partners

The enrolment period for 2019 health insurance begins on November 1st and ends on December 15th. If you haven’t decided on your insurance for next year, then now is the time to start comparing your options.

The licensed insurance experts at Mutual Health Partners can offer you the very best plans based on your current needs and your history. We will help you to find the perfect balance between affordability and coverage for your unique situation.

Contact Mutual Health Partners today to get your essential medical insurance coverage for 2019.


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