Did you know the majority of workers getting health insurance through their employers use PPOs? As a result, PPOs make up almost 50% of the market share.
Low-wage workers and small businesses benefit from using PPO plans for their health insurance.
On average, premiums for PPO health insurance are higher. But, this is not true for low-wage workers. The premium costs are 5-10% lower than other plans.
But what is PPO health insurance? Is it the right plan for you? This article will explain what you need to know and help you choose the best health insurance plan for you and your family.
What Is PPO Health Insurance?
Preferred Provider Organization health insurance plans, or PPO plans, are managed care health plans. They serve both single payers and families.
PPOs have lists of healthcare providers that they prefer you use. Insurance companies call this in-network.
By using their preferred doctors, hospitals, and other providers, you pay less. However, when you see someone outside the network, you pay more.
Therefore, out-of-network fees can be significantly higher than seeing someone in-network. Using the network and getting prior authorization for some services keeps costs low.
How Does a PPO Work?
PPOs use cost-sharing. You pay part of the cost in the form of deductibles, coinsurance, and copayments. You will need to pay your deductible in full before any insurance kicks in.
Cost-sharing ensures you really need the healthcare services you are getting. This is why prior authorization is sometimes needed.
Within the PPO network, there are more than just physicians. All healthcare services you may need will have someone listed in the network should you need it.
If you wish to see someone outside your insurance company’s network, you will need a referral from someone in-network.
The Benefits of a PPO Plan
With PPO health insurance, you have more freedom. For example, you don’t have to choose a primary care doctor.
If you need to see a specialist right away, usually, you can go without needing prior authorization. However, it is always best to check with your insurance company first.
PPO plans cover prescription drugs in most cases too.
As mentioned before, out-of-network expenses will be higher. But, with a PPO plan, a portion of the fees will be covered by the insurance company.
This is different from health insurance plans like Health Maintenance Organization (HMO). HMOs won’t cover any out-of-network expenses.
Thanks to the Affordable Care Act (ACA), new health insurance plans cannot require cost-sharing for select preventive services. However, keep in mind the ACA’s out-of-pocket maximum only covers in-network services.
Should you need preventative care, it is available to you.
Time to Get Health Insurance
Now that you understand PPO health insurance, you feel more confident in choosing the health insurance plan that is right for you and your family.
We know the process is still overwhelming. If you need more health insurance advice, don’t hesitate to contact us at FutureWise today. Our healthcare experts can help with all of your questions.