PPO Health Insurance Plans - The Pros & Cons

PPO is short for Preferred Provider Organization. PPO health insurance plans are based on contractual relationships that the insurance companies have with the organizations. The term "organizations" refers to the healthcare providers, doctors, hospital, clinics, etc.

Thus, PPO plans have pre-approved lists of healthcare providers called the Participating (In-Network) Provider list. But they also allow you to see healthcare providers who are not on the list called the Non-Participating (Out-of-Network) Provider list.


Note that when you use a non-participating provider you will end up paying more than if you had used one in-network.

PPO Health Insurance Plans - The Pros & Cons


  • Access: You have access to a larger number of doctors and facilities.
  • Choice: You can chose whatever doctor you want to see for your healthcare needs.
  • Specialists: you do not have to have a referral to a specialist.
  • Primary Care Physician: You do not have to chose and be tied to a primary care physician.
  • Negotiated Fees: When you use a participating provider, the amount charged will be a negotiated amount less than the provider would charge someone without the plan.

  • Deductible: There is almost always a deductible to be met.
  • Co-Insurance: After the deductible is met, there is a co-insurance amount that you are responsible for paying the average being 30% of the cost.
  • Out of Pocket Expenses: Overall, PPO plans cost you more between the deductible and co-insurance and other out-of-pocket expenses.
In the end it comes down to what is important to you. Are you willing to pay extra for open access to the healthcare provider of your choice?

Whether you want a PPO, HMO, or HSA, you should consult a local health insurance agent or broker to help you find the right plan.

PPO Health Insurance Plans - The Pros & Cons

Corinne Mitchell has worked in the insurance industry for 10+ years and currently works with the Group Insurance Benefits Specialists at http://www.nicoins.com

Read her blog http://www.groupinsurancebenefitsspecialists.com/ for more tips.

Make sure you get expert advice and find the right coverage for you and your employees.