What is a PPO Plan?
Whether for health or dental coverage, a PPO insurance policy typically offers cost savings when utilizing in-network doctors, hospitals, or facilities. Unlike other plan types, such as Health Maintenance Organizations (HMOs) or Exclusive Provider Organizations (EPOs), a PPO stands out for its flexibility by permitting visits to out-of-network providers, albeit with potentially higher costs. An important exception is emergency care, where under the Affordable Care Act (ACA), insurers are mandated to cover out-of-network costs, recognizing the urgency and lack of choice in such situations. Another distinguishing feature of PPO plans is the freedom to consult any doctor without a referral. Unlike some health plans that necessitate a visit to a primary care physician (PCP) for evaluation and specialist referrals, PPOs empower individuals to access the care they need directly without designating a PCP. This flexibility sets PPO plans apart, providing a more accessible and streamlined healthcare experience for policyholders.
What are the Pros of a PPO?
- Choice: You get access to a more extensive network of doctors and hospitals to choose from. You do not have to commit to a single primary care physician, which can be especially advantageous if you travel frequently or can’t consistently see the same doctor for some reason.
- No Referrals: Many plans require a referral to see a specialist. With a PPO plan, you don’t need this, so you can save time and money by skipping that step and accessing the specialized care you need.
- Out-of-Network Availability: While an in-network provider is recommended, you can still seek care from an out-of-network provider on a PPO plan. Using an out-of-network provider will cost you more out of pocket but offers you the flexibility to make that choice.
What are the Cons of a PPO?
Before enrolling in a PPO plan, you should be aware that there are a few disadvantages to this type of insurance plan.
- The monthly premiums are typically more expensive.
- You will have an annual deductible.
- If you get in-network care, the providers file the claims, but for out-of-network care, you are responsible for filing the claim.
Consider opting for a PPO plan if you prioritize having a broader selection of choices in your health insurance plan and have the financial flexibility to accommodate it. However, it’s crucial to thoroughly assess all available options before making a final decision to ensure it aligns seamlessly with your individual needs and preferences.
Contact Tom Miroballi today!
Tom Miroballi, Independent BCBS Agent, will help you evaluate and select the right insurance package to make your healthcare work for you. Before signing up, Tom will explain the terms and rules of whether the plan will cover something you need.
Affordable health insurance is just one call away! Give Tom a call at 630-863-3477 or email him today!