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A Preferred Provider Organization (PPO) is a managed care product. It is health insurance available to consumers that have structured benefits and a professional network of medical professional.
Even though a PPO encourages its members to stay in network by promising a negotiated rate or contracted rate you have the freedom to see any professional you would like and still get some benefit.
With these plans as you incur medical expense they will go towards what they call a deductible. A deductible is a dollar amount such as $2000 that you will have to meet before the insurer will share cost with you.
All of your incurred medical expense will go towards the deductible. If you met this in a year the insurer will then share the expenses with you. They pay 100%. More often the have a co insurance amount to met. They may split expenses 80/20 at this time. You would pay 20% and they would pay the 80% that remains.
Either way they will have an “annual maximum out of pocket” that you would be required to pay. So if you had a $3000 deductible and a $2000 co-insurance max you could pay up to $5000 out of your own pocket before the insurance company paid 100% of expenses.
A PPO may also have set dollar amount for specified medical treatment called a co-payment. A co-payment would be due if you incur these specified treatments. Office visits and prescriptions typically have co-pays.
Consumers really like the freedom of choice that a PPO provides to them. They can see any medical professional and still get some sort of benefit. With a HMO you must only see providers that are in the network.
You will need to become familiar with all of the facts in regards to a PPO product. Compare all the facts with your needs and budget before deciding if it is for you. This article has covered some of the basics, but there is more to know.