What is a PPO Plan?

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Basic Understanding of a PPO Plan

A PPO, or a Preferred Provider Organization plan, is a popular insurance option amongst many due to its ease of use and accessibility. A PPO includes a network of health physicians that are readily available to insurance holders at all times, without the need of a referral from a physician. Since you do not need a referral from a physician, PPOs can be useful since you will not need a primary care physician and can just visit health professions on a case-by-case basis based on your needs at the moment. Clients are strongly suggested to use the in-network physicians for lower costs, but the insurer will stay a portion of any out-of-network visits as well.  

Costs of a PPO Plan

PPOs generally cost more than an HMO plan, also known as Health Maintenance Organization plans, which are also common amongst insurance users. Since PPOs offer more flexibility, and still offer partial coverage for out-of-network visits, the premiums and annual deductible and copayments may be higher. Although prices vary depending on the insurance organization, copayments typically range from $10 – $30 or is a set percentage made by your insurer. In comparison to Medicare, this is typically a more expensive option, but you get more freedom with your plan and more benefits as well.

How Referrals Work in This Network

With a PPO plan, you will not need referrals for visiting any healthcare provider, whether it is a clinic, hospital or specialist. However, it may be easier and is often recommended to visit specialists within the designated network in order to get the most budget-friendly option and avoid the most amount of paperwork. Out-of-network providers also do not require a referral but will come at a higher cost. 

Is a Primary Care Provider Required in a PPO?

You do not need a primary care provider if you have a Preferred Provider Organization plan. Since you do not need any referral to visit specialists, you do not need a primary physician to handle these accommodations. With a PPO plan, you have the flexibility and freedom to visit any healthcare professional you need within the network and outside of the network. However, if you choose to visit an out-of-network provider, you should expect higher costs.

How Does It Compare To Other Insurance Plans

If you are not interested in a PPO plan, there are many other insurance plan options to choose from. A few of these options are listed below that vary in budget and health needs. 


An HMO, or Health Maintenance Organization plan, is a cheaper option in comparison to a PPO, but it comes at a cost of less freedom. With an HMO, you should only use in-network health professionals. If you choose to use an out-of-network provider, the insurance company will not pay any portion of your visit. Additionally, with an HMO you will need a primary care provider and they will need to give referrals for any specialist visit. The costs for HMOs are cheaper but come with a higher deductible in return for a lower monthly cost.


An EPO, also known as an Exclusive Provider Option, is an option that is cheaper than a PPO but usually has more expensive monthly premiums than an HMO plan. With an EPO, you are given a network of providers and will not get any coverage for out-of-network health professionals unless it is in the case of an emergency. However, similar to a PPO, you do not need referrals to visit any specialist which can be convenient for many situations.


A POS, or Point of Service Plan, is a combination of a PPO and an HMO. It has the flexibility of a PPO which allows you to visit out-of-network providers and receive partial coverage, but at a higher cost than an HMO. It is similar to an HMO since it requires a primary care physician and referrals to visit any specialist. This option is typically higher than a HMO or EPO but has more flexibility. 

Why Should You Choose a PPO Plan?

PPO plans are typically popular amongst individuals and families that require a vast variety of needs. A PPO is the right option for you if you can afford to spend more on annual premiums and deductibles and enjoy the flexibility of choosing your provider. If you do not need a primary care physician for frequent visits, a PPO can be a great option for you.

Finding The PPO Plan Ideal For You

PPO plans vary greatly depending on the region and the state in which you live. Most factors such as service fees, premium costs, and of course, the network of professionals will vary depending on where you live in. If you are interested in a PPO plan, follow our form to compare rates and policies from different providers.

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