A Preferred Provider Organization, commonly called a PPO, is a health plan that contracts with doctors, hospitals and other medical providers to form a participating provider network.
Members generally pay less when they receive covered care from providers in the plan’s network. A PPO may also allow members to use out-of-network providers, but the member will usually pay more.
PPO plan rules, benefits, service areas, provider networks and out-of-network coverage vary by insurance carrier and specific plan. Always review the plan documents before enrolling.
PPO plans have a contracted network of doctors, hospitals and other healthcare professionals. Using participating providers generally results in lower member costs.
Many PPO plans permit covered care outside the preferred network. Out-of-network deductibles, coinsurance and other charges may be substantially higher.
PPO plans commonly allow members to visit specialists without a primary care referral, although preauthorization or other plan rules may still apply to certain services.
Compare premiums, deductibles, copayments, coinsurance and maximum out-of-pocket limits. A plan may apply separate cost-sharing rules to out-of-network care.
Confirm that preferred doctors, hospitals, specialists, pharmacies and prescription drugs are included under the current plan network and formulary.
Review covered benefits, exclusions, medical necessity rules, prior authorization requirements, service areas and claim procedures.
Some discount arrangements and alternative health products may use the term “PPO” only to describe access to a provider network. That does not necessarily mean the product is comprehensive or ACA-compliant health insurance. Review the policy, Summary of Benefits and Coverage, exclusions, benefit limits and regulatory status before purchasing.
Tell us about your location, household, preferred doctors, prescriptions, anticipated care and budget.
Review available network structures, costs, benefits, exclusions and out-of-network provisions.
Receive assistance understanding application information, enrollment requirements and next steps.
Contact Insure With Asif to discuss plan availability, provider networks, costs and coverage considerations.
Plan availability, network type, costs, benefits, eligibility, provider participation and out-of-network coverage vary by applicant, location, carrier and plan. Insure With Asif is not a government website.