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Are PPOs a Good Choice for Your Health Care?

Christian Worstell by Christian Worstell    |    Published Oct 03, 2019    |    Reviewed by John Krahnert

A Preferred Provider Organization (PPO) is a type of managed care organization that provides access to a network of doctors, hospitals, labs, pharmacies and other health care professionals.

These providers, called “preferred providers,” have agreed to offer services at a discounted rate. You can use providers outside the network, but you’ll pay a higher rate.

Some PPOs will allow you to visit a specialist without first getting a referral from a primary care physician within your network. But for the more expensive treatments, you will in most cases need to get that referral.

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Other Types of Insurance

PPOs aren’t your only option when it comes to health insurance. Other popular insurance options include HMOs and Medicare (for people who are eligible).

Health Maintenance Organizations (HMOs)

Health Maintenance Organizations (HMOs) are an alternative to PPOs. HMOs generally limit coverage to services from health care professionals who work for or contract with the HMO and won’t cover out-of-network care, except in an emergency.

HMOs usually require you to choose a primary care physician from its network. Your primary care physician coordinates your care. You typically need a referral from him or her to see a specialist.

HMOs often focus on prevention and wellness, as well as integrated care.

Medicare

Medicare is a federal health insurance program for people age 65 and older and people with certain disabilities or ESRD.

Original Medicare (Medicare Part A and Part B) provides coverage for numerous hospital and medical costs. However, it does leave some out-of-pocket expenses to recipients in the form of deductibles, copayments and coinsurance.

Medicare Supplement Insurance helps cover some of these out-of-pocket costs to help make your health care bills more predictable and affordable.

To learn which Medicare Supplement Insurance plans are available in your area, speak with a licensed agent at --ms-tfn-- .

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