Preferred Provider Organizations or PPO Insurance

PPO insurance is a managed care plan with more flexibility than an HMO.

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PPO insurance: the basics

A PPO health insurance plan provides lower cost health insurance with some limitations.

PPO insurance does have a network of providers; however no primary care physician is required and referrals for specialized medical services are not needed. Non-network care will cost more.

PPO insurance: the pros and cons

  • Health care costs are low for network care.
  • You can consult any specialist, including non-network ones.
  • Having a primary care physicians is not required.
  • You complete paperwork for non-network care.
  • Out-of-pocket costs are limited.
  • Cost of non-network care is expensive.
  • Co-payments are larger than with other managed care plans.
  • You may need to satisfy a deductible.

PPO insurance: the price

Of the managed care plan, PPO insurance is the most expensive because it allows the most freedom.

How much will you pay? Monthly premiums, coinsurance, or a co-payment.

For non-network care, you pay a deductible and a higher co-payment.

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PPO insurance: questions

For easy comparison, ask these questions about any policy you're considering:


  • How many doctors are in the network?
  • Are network doctors private or group practice physicians?
  • Are the offices and hospitals conveniently located?
  • What is the specialists referral procedure?
  • Which hospitals are in the network?
  • How is emergency care handled?
  • What medical services are covered?
  • Are there limits on certain services?
  • How much are annual premiums?
  • How much are the copayments?
  • What is the extra cost for non-network physicians?
  • How much are the deductibles and coinsurance for non-network care?
  • Is there a maximum for out-of-pocket expenses?


Here is a printer-friendly version of this questionnaire.


Next: POS plans

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