Learn the Pros and Cons of PPO Plans
There is no requirement for personal recommendations.
The requirement of a referral to see a specialist is eliminated when you are not tied down to a single primary care physician. To see a specialist under other plans, such as an HMO, you must first schedule an appointment with your primary care physician, who will then issue you a reference.
If you need specialized care but don’t want to waste time and money waiting for a recommendation from your primary care doctor, you can skip that step and go straight to the specialist.
Connectivity independent of a network
It is suggested that you see a provider within your network, but you may still be eligible for some financial assistance if you visit a provider outside of your network. Only your out-of-pocket expenses will be higher than they would have been if you had visited one of the network’s preferred providers.
If you have an HMO plan, for example, you can only see doctors who participate in that plan’s network. If you see a doctor who isn’t part of the network, you won’t be reimbursed for any of your medical expenses. The only time this won’t apply is if you’re in dire need of medical attention.
Negative aspects of PPO insurance plans
And now, the bad news. You should think about the potential drawbacks of a PPO plan before signing up for it, as it could result in somewhat higher out-of-pocket costs for medical care.
Higher monthly premium costs
PPO plans are usually the most expensive option available. Plan premiums will be higher, and you’ll have to pay more out of pocket each year before your insurer begins paying its portion.
According to KFF data, the average rates for single and family coverage for insured workers participating in PPO plans are higher than the national average. In 2021, the average cost of a PPO plan premium will be $7,731 for an individual and $22,221 for a family1.
By contrast, the average costs of an HMO plan are far cheaper, at just $7,016 for an individual plan and $20,809 for a family plan. Seeing a provider that is not included in your plan’s network will also result in higher out-of-pocket expenses.
