Preferred Provider Organization (PPO)

What is PPO health insurance?

PPO health insurance also known as Preferred Provider Organization plan is a healthcare plan where you can visit a physician in- or out- of network. You are under Primary Care Physician or PCP who will conduct all you medical check ups at zero out-of-pocket cost. Unlike HMO, you may or may not choose to get your PCP referral for in-network consultation. You need to have your PCP refer you for out-of-network consultation.

Why do you need PPO health insurance?

  • When you need regular health check ups

For your daily healthcare requirements, if you were to pay out-of-pocket and deductibles from your general plan, it will become really expensive. With a PPO along with your general plan, you do not have pay every time you need medical help. Your PPO will provide you huge deductions within the plan.

  • You are a PPO plan enrollee, you get regular medical care at huge discounts.

For all patients with chronic symptoms, you are entitled to regular prescription drugs, visit to physicians, or even specialists under PPO health insurance.

  • All your medical costs under PPO health insurance will be covered, as insurance companies will

pay to the in-networks within your PPO for your medical care.
When you visit any specialist within your network, your costs are borne by the PPO. This happens as the insurance providers are asked to pay for your in-network medical concerns.

  • Your PPO will negotiate what should be your medical cost

For all your tests, health checkups, visit to the emergency room, out-patient consultation, or in-patient admissions, it is your PPO that will decide what costs you will pay.

  • You don’t have to worry about the conflicts between insurers and the carriers.

Whether you choose Aetna, Humana, or any other carrier, your insurance provider will negotiate what on the premiums you have to pay, what out-of-pocket costs, etc. you will pay. There are some fixed rules that every carrier has to follow when the enrollee looks for PPO health plan.

  • Your PPO will provide the solution.

In case of serious health conditions, the kind of medical care you need, your PCP will decide it for you. He will generally provide you a list of in-network specialists, you can choose from. In case you wish to show someone from out of network, your PCP can refer you.

  • PPO insurance makes direct contracts between networks so that you don’t have to switch providers to get medical coverage for different networks.

Your PPO health plan will take care of providing the fees for your treatments, checkups, and other medical needs irrespective of the provider you choose. For all networks, your PPO healthcare plan will manage your care and expenses.

  • There is a catch in PPO. Your insurance provider will scrutinize your test reports and decide if you need extra medical attention.

Don’t be overjoyed that you will get all your medical needs covered. If you create unnecessary medical requirements, your PPO will check all your reports and decide if you actually need these treatments.

Your HMO health insurance plan does not allow you to afford its services in case you pick health care from out-of-network, other than in genuine emergencies. With PPO health plan, you are allowed to choose both in-network and out-of-network medical facilities, however, you will pay much lesser cost if you choose in-network facilities. In an event where you are buying health insurance for the first time, choosing a PPO health insurance may be wiser solution for you. In PPO, you may get your prescription drugs covered if you join a plan that covers drugs in its plan.

PPO plans will only be suitable if:

  • Require to be free to select the health care provider according to your needs.
  • If a part of out-of-network costs you wish your insurer to cover.
  • You don’t need referrals before you have visited a specialist.


Once you are enrolled with PPO health insurance plans, you will be under your health insurance coverage even if you are showing out-of-network. However, your reimbursements will have comparatively higher deductibles, and out-of-pocket payments than in case of in-network. However, for EPO there is no reimbursement provided for out-of-network consultation and medical care.

PPO Dental Insurance plans

Your dental care is one of the most regular and essential health facilities you need. With a PPO dental insurance plan, you will get both in-network and out-of-network coverage along with a PCP dentist.

PPO Vision Insurance plans

For your eye care, you can receive almost all facilities at a huge discounted rate. Your regular eye checkups with your optician, glasses, and also surgery can be done at much less cost if you are within your in-network care.

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