5 Things to Know About a PPO

When it comes to health insurance, understanding all your options can be confusing. There are a lot of choices. It may be hard to know which health plan is best for you and your budget.

Many Americans get health insurance through their employers. Others look for coverage through the Health Insurance Marketplace.  If you are part of an employer’s group plan, a preferred provider organization (PPO) is often one of your choices.

Here are some key things you should know about PPOs.

1. A PPO offers a network of health care providers.
   A managed care network of doctors, hospitals and other providers like dentists and eye doctors is a core feature of a PPO. They contract with insurance companies to offer care at more affordable costs to patients. When you see a doctor or go to a hospital in your network, you'll enjoy lower prices. You can still use a doctor out of your network, but it will cost more.
2. A PPO is just one type of health plan.
   Most people have access to PPOs through their employers, but not everyone. If you can’t choose a PPO insurance plan, one of these three options may be a good choice:
   
   •  Health maintenance organization (HMO)
   •  High deductible health plan (HDHP)
   •  Consumer-driven health plan (CDHP)

   If you can participate in a PPO and are worried about high health care expenses, a PPO might be right for you.

   If you rarely go to the doctor and have no health concerns, then you may decide to buy a plan with lower monthly premium payments. Think about your current health care needs and finances before making a decision. When you choose carefully, it can help you save money.

3. Know what you get with a PPO Plan.
   Access to a broad network of doctors, hospitals and other care providers at a negotiated rate is a big benefit. With a PPO, you have a flat copay fee for things like doctor and hospital visits. You may have to meet a deductible, but once you do, you only pay a percentage of the cost for covered services. Preventive services are covered at no cost to you when you see a doctor in your network.
   
   With a PPO plan, you save money when you use doctors, hospitals and other providers in your network. Once you hit your out-of-pocket maximum, your health plan pays qualified medical expenses  set by the Internal Revenue Service (IRS) at 100 percent. If you have an ongoing medical condition, or need to plan for an upcoming medical expense like surgery, a PPO plan may be right for you.
4. Know what's not part of a PPO.
   Not all doctors take every PPO health plan. Use the Blue Cross and Blue Shield of Texas Provider Finder^® to make sure your doctor or hospital is in your PPO network
5. Know the differences between a PPO and other health plans.
   Your monthly premium can be higher in a PPO than with other health insurance plans. Your health insurance company pays a part of your doctor visit with a PPO. You can also help pay your medical bill with a Flexible Spending Account.

Just remember, it’s smart to weigh a PPO’s higher monthly premiums along with copays for tests and doctor visits. On the other hand, a PPO offers more coverage. You also pay less at doctor visits and when you have hospital stays, surgeries and costly medical tests.

Compare features and choose the best health insurance plan for your needs.

Sources: Health Insurance Plan and Network Types,  Healthcare.gov; Medical and Dental Expenses,  IRS, 2022.

Originally published 6/14/2016; Revised 2021, 2022, 2023