Preferred Provider Organization (PPO)

A PPO is a type of health insurance plan that will usually allow you to pay less if you use a doctor, hospital or facility that is within the network..

 

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What is a provider network?

A provider network is a list of the doctors and hospitals that a plan has contracted with to provide medical care to its members. These are called "in-network" providers. Providers that are not contracted with the health insurance plan are designated as "out-of-network" providers.

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A PPO insurance plan also allows you to visit any doctor without the need for a referral. In some other health plans, you may need to first visit your primary care physician (PCP) to get evaluated, and then you would be able to go to a specialist once your PCP has made the referral.

 

PPOs allow you to bypass this and won't require you to select a PCP for your health insurance.

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In addition to where you receive care, different networks will also determine how much you will pay for those health services. This makes choosing a health policy with the right network for your needs extremely important. We have provided detailed descriptions of each provider network compared to a PPO below.

 

HMO vs. PPO

The main difference between a health maintenance organization (HMO) and PPO is that you will need to designate a primary care physician (PCP) who will coordinate your care if you have an HMO health insurance plan. In this case, you will also have to receive a referral from that PCP in order to visit any specialists and most likely will need to pay full price for any health services out of your network.

An HMO will have a slightly cheaper premium when compared with a PPO policy since you have tighter restrictions on where you can receive care.

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