What is a preferred provider organization?

Preferred Provider Organization (PPO) is a network of medical providers that contract with the organization to reduce coverage costs for PPO participants. In exchange for the reduced coverage costs in the network, participants pay subscription fees to the PPO. Providers outside of the network can still be used, but at an additional cost to the subscriber.

The premiums for PPOs are typically higher than those for HMOs. However, HMO networks do not have the same flexibility as a PPO.

What do I need to know about preferred provider organization coverage?

Preferred Provider Organization Benefits

The main advantages of PPO coverage is the greater freedom and flexibility of the plan. Especially when compaired to an HMO plan. PPOs usually have wider areas of coverage, and allow for coverage outside of the network. Also, participants are not required to select a primary care physician. This means that they can see any in-network doctor, and can visit a specialist without a referral. Copayment plans may also be another advantage, depending on the participant’s needs. Having a copay means the participant will have a small fee to pay upon reciept of care.

Preferred Provider Organization Insurance can offer greater freedom than other coverage plans
preferred provider organization plans may cost more than other plans

Preferred Provider Organization Care Costs

Most of the disadvantages relate to the higher costs of PPO plans. Because PPOs cost more for the organization and the health care providers to manage. Essentially, the PPO participants are paying for the increased flexibility in their plan. As a result, some PPO plans may implement deductibles, which is a pay checkpoint that the subscriber must pay before the insurance provider begins paying for care. Subscribers should also be aware that if care received out-of-network exceeds a reasonable limit, the PPO coverage may not apply.

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At Buffalo Health Advisors, we believe in providing solutions to seniors as they transition to Medicare plans. Not only can Medicare Advantage work to protect your health, choosing the right plan can go a long way toward protecting your wealth. This plan is critical if you are going to be living on a fixed income during your retirement years.

Learn more about your availible options at no cost to you! Call or stop by our Nashville, TN office to discuss your Medicare plan options with one of our experienced agents.

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Compare Medicare Advantage plans to find the best match for your personal needs with no obligation!

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