A PPO plan stands for “preferred provider organisation.” With a PPO plan, you’re not required to select a PCP or visit only doctors within a specific network. Instead, you can visit any doctor or use any medical facility of your choosing (as long as you’re willing to pay the out-of-pocket cost for that service). PPO plans, though, do require you to pay a little bit more out-of-pocket for each service because those plans are more flexible than HMO plans. With a PPO plan, you will have to pay the full cost of each doctor’s visit, as well as the full cost of any specialty treatment you receive. You’ll also have to cover the cost of any prescription drugs you need.
Such benefits can include:
- Adult day-care services
- Fitness memberships
- Nutrition programs
- Over-the-counter drugs
- Services and supports for those with chronic conditions
- Transportation to doctor visits
- Wellness programs
Pros And Cons
Many people who are healthy and rarely sick choose PPO plans. PPOs are great for people who want to have flexibility in their health care. Unlike HMOs, you can use any physician you like. You can also use any medical facility of your choosing, and you can even go to an urgent care or an emergency room if you need to. PPOs come with a higher out-of-pocket cost because the insurance company doesn’t have a set amount that they’re willing to pay for each service. PPOs are great for people who are healthy and rarely sick, but they’re also a good choice for people who have chronic health conditions. PPOs give you the flexibility to go to specialists and physicians you need, but you won’t be forced to go to a PCP you don’t like or trust.