Will A PPO Health Insurance Plan Work For You?
PPO or Preferred Provider Organization is a group health care system that is organized by a health insurance provider. With the PPO system, physicians, hospitals or clinics and other types of health care providers sign contracts to provide care to the clients of the insurance company. These health care providers follow the insurance company’s guidelines and accept PPO’s fees. With a PPO health insurance plan, the insured will get discounted rates. With a PPO health insurance plan, the insured can avail discounted health care service from the group health care system of his or her health insurance company.
How does PPO work?
Before the health insurance provider start paying medical fees, the person will have to pay a yearly deductible. Once this deductible is settled, the health insurance provider will start to pay a portion, usually 80 percent, of the medical fees for the in-network physicians. The insured is responsible for the rest of the bill. Each time the insured seeks medical service, he/she has to pay a co-payment. In case the insured chooses to consult an out-of-network physician, he/she may do so without asking permission from the insurance company. However, the deductible for out-of-network health care services may be higher and the subsidy of the insurance company may be lower. This means that the patient will have to pay a greater part of the bill. Thus, if enrolled in a PPO plan, it is advised to use the physicians and other health care providers in their network.
Why Choose a PPO Plan?
The good thing about getting a PPO health insurance plan is that it offers great flexibility or options for the insured on who to consult with. Also, you do not need to have a referral to a specialist and you are not tied to a primary care physician. As long as they are within the medical network of your health insurance, you are guaranteed to avail discounted medical service. Moreover, you can choose to consult physicians that are out-of-network, although it may require out-of-pocket expenses. Most PPO networks also include prescription service and offer prescription drugs at a reduced cost. There is also a large network of health care providers you can choose from.
The Disadvantages of Choosing PPO Health Insurance Plan
Choosing a PPO health insurance plan would require a deductible. If your deductible is low, you will have to pay higher premiums. Moreover, after the deductible is met, you will still have to pay an average of 30% of your medical costs. Especially if you will choose physicians and health care institutions that are not within your PPO network, you will have to pay for an extra cost.
Although a PPO health insurance plan is a good option, it is important to consider whether you are likely to consult a physician that is not within your insurance’s medical network. Moreover, before purchasing such insurance, make sure that there are many health care providers that are part of your medical network so as to avoid more expenses.