What is a PPO?

Posted April 7 2021


Happy male medical doctor portrait in hospital. Portrait of a male doctor with laptop sitting at desk in medical office. Portrait of a happy young doctor at medical office desk.Are you trying to decide what type of insurance plan would best benefit your employee group? Let us help explain some options!

Preferred Provider Organization (PPO) is a type of health insurance plan that operates with a network of participating providers such as primary care physicians (PCP), doctors, and hospitals. Typically, costs are less when associated with providers that are within said network, however you can still use providers outside of the network for an additional cost.

As opposed to a PPO, a Health Maintenance Organization (HMO) is a type of health insurance plan that operates with a network of participating providers, much like a PPO, however there is no coverage offered if you use a provider that is outside of the network.

What is the difference between a PPO and an HMO?

The main difference between a PPO and an HMO is that a PPO offers you more freedom to see the providers you want to, whether they are in your network or not. While a PPO still operates with a network of providers, there is still coverage offered if you choose not to go within network.

What are the benefits of a PPO?

· Flexibility to see a primary care physician you like whether in network or not

· Freedom to see doctors and specialists without the need of a referral, including those out-of-network

Who does a PPO work best for?

While PPOs are considered to be a more luxury option, don’t let that label fool you, according to the Kaiser Family Foundation’s 2019 Health Benefits Survey, “PPOs are the most common plan type, enrolling 44% of covered workers in 2019.” Even though they are the most common, those who benefit most from these plans would be people with chronic health issues, those that require to see a specialist often, or those who are elderly. Typically, the older you get, the more time you spend at the doctor, which is why a PPO is so appealing to people who frequent doctors, because they get a say in who they get to see. Maybe you are more comfortable with someone, or already have years’ worth of trust and experience with a specialist, sometimes these attributes can be seen as priceless.

Selecting the right health insurance plan for you or your employees can be a difficult task, but the experienced insurance brokers at MHG are glad to help you sort through the terminology and key features to determine the best health insurance plan for your situation. Our Insurance Specialists will help you assemble a complete insurance offering that includes health insurance, gap insurance coverage, life insurance, disability, and more. Call us today at 954-828-1819 or visit us online at mhginsurance.com for help in selecting the ideal health insurance plan for you and/or your employees.