What Is a PPO Health Insurance Plan? Discover the Benefits of PPO Plans 

Understanding the pros and cons of different types of health insurance coverage is crucial when making enrollment decisions. Two of the most popular options with North Carolina insurance companies are PPO health insurance and HMO plans. 

The experts at Carolina Insurance Professionals explain what a PPO health insurance plan is. How does it differ from an HMO insurance plan? Most importantly, learn when a PPO healthcare insurance plan is better for yourself or your family health insurance plan than HMO care plans. 

PPO Health Insurance Explained

PPO stands for Preferred Provider Organization. When you’re in a PPO, you have a network of healthcare providers – doctors, hospitals, specialists, and other medical providers – who’ve negotiated discounted rates with the insurance company. You still have the freedom to choose out-of-network providers when desired or necessary. 

Take a closer look at a PPO and what it entails:

• Deductibles: Many PPO health insurance plans require you to meet a deductible before coverage begins.
• Coinsurance: Once you meet your deductible, coinsurance is the percentage you’re required to pay out of a medical bill. If you’re on an 80/20 plan, your health care insurance provider pays 80% of the bill, and you pay the remaining 20%.
• Copayment: Also known as a co-pay, this is a fixed amount you pay for different medical services, such as a $50 co-pay for any visits to an emergency department or prescription drug coverage that requires a $10 co-pay on generic prescriptions.
• Out-of-Pocket Maximum: Any PPO plan has a maximum amount that you must pay out of pocket for healthcare. Once you meet the maximum for out-of-pocket expenses, healthcare insurers cover 100% of any healthcare costs you incur for the rest of the year, limiting the financial impact from catastrophic injuries or illnesses.
• Provider Network: These are the preferred providers who enable you to benefit from lower out-of-pocket costs.
• Out-of-Network Coverage: If you go to a doctor or medical facility that’s not a preferred provider, you’re still covered; however, you typically pay a higher deductible, co-pay, or percentage of the coverage.
• No Referrals: Pre-authorization or referrals are needed by your primary care physician (PCP) if you want to see a specialist.

HMO vs PPO Health Insurance

As you navigate your healthcare and insurance options, you’ll find HMOs are another choice for individual health insurance or family healthcare coverage. They may be a better fit, but it depends a lot on your specific needs when it comes to seeing a doctor.

HMO stands for “Health Maintenance Organization.” This health plan works by having a PCP who determines when you need to see a specialist within the network. 

An HMO insurance plan has lower monthly premiums and out-of-pocket costs, but you have less control when it comes to seeing a specialist. If you’re out of state or out of the country, you may need authorization before you visit a hospital, clinic, or doctor to ensure coverage by your health insurance program.

PPO health insurance puts a stronger priority on giving you a choice. In exchange for slightly higher premiums and healthcare costs, you have the freedom to go out-of-network without referrals or prior authorization.

When Should You Consider PPO Health Plans?

PPO plans are best for healthcare coverage when you want:

• Ability to keep seeing your current care providers if your doctor or healthcare practice isn’t in network.
• Flexibility when it comes to choosing healthcare providers.
• More control over your healthcare decisions.
• No more waiting to get a referral to see a specialist.
• Pre-existing conditions have you comfortable with your team of doctors and specialists, and you don’t want to change to someone new.
• You travel frequently and aren’t always near physicians and specialists in your PPO network.
• Your child is attending college out of state and needs student health care coverage while away from home.

Get Expert Guidance When Enrolling in PPO Health Insurance

Now that you know what a PPO health insurance plan is, work with a health insurance company in North Carolina that offers advantageous health benefits and low health insurance rates. Carolina Insurance Professionals helps you navigate your options and find the best health insurance quotes for your or your family’s healthcare needs. 

There’s no certainty in your health from one day to the next. You could slip on wet grass and fracture your wrist, resulting in the need for expensive X-rays and follow-up care. An optimized PPO health plan makes a difference in your finances. 

Get started on affordable health insurance plans in North Carolina by completing Carolina Insurance Professional’s online form or calling (919) 285-4732 for an insurance agent for immediate assistance. Compare plans to find affordable care.