The best way to find a PPO, or Preferred Provider Organization, health insurance plan is to research companies available to you. PPO is a major medical plan and many companies offer this type of policy.
Online health insurance options are available using the free ZIP code search tool located on this page. You can find rate and coverage comparisons.
When searching for a PPO health insurance policy make sure you research all different types of policies available to you. This will insure you chose a policy that best fits your needs. Sometimes you may be limited by the type of policy you can choose or providers available. One example of this is if you are using Medicare Advantage.
According to the Department of Health and Human Services, PPOs are growing in popularity with people on Medicare Advantage plans. You will still want to compare each policy’s coverage though.
What is PPO health insurance?
There are several different types of health insurance available. PPO is a very common type that uses contracts with providers to set up a network where they receive discounts on services. Insurance companies like this type of plan because they do not have to pay out as much. Many consumers like this type of PPO policy as well.
PPO plans offer or require:
- Flexibility: It gives you the flexibility to choose doctors and facilities on the insurance company’s network or go off network for a slightly higher price. Your policy outlines set health insurance co-pays based on the type of service and whether you are in or out of their network.
- Deductibles: You will also have an annual deductible. This is a set limit of out of pocket costs you must pay before the insurance company starts to pay claims. This is used for any specialty care or tests that are not considered routine in your policy.
- No Referrals: Another benefit to a PPO is you can see any doctor on the network without a referral. If you need to see a specialist you do not have to wait for approval from the insurance company. Your policy should include a cost schedule for seeing specialists on and off the network.
What other types of health insurance are available?
According to the South Carolina Department of Health, there are three other types of major medical health insurance policy. They are Indemnity, Point of Service (POS), and Health Maintenance Organization (HMO).
How do indemnity health insurance plans work?
Indemnity insurance plans work off a deductible system. You will be required to meet your annual deductible before the company starts to pay. This will be on all services including preventive care. After your deductible is met, your health insurance company will pay a set percentage of future claims. Most companies set this at 80% but read your policy carefully.
This plan offers the most flexibility in where you receive care. They do not have a set network so you are free to choose any doctor or hospital you want. You also do not need a referral to see specialists.
How do HMO plans work?
HMO health insurance plans will have you choose a primary care physician. All of your care will be provided by this doctor. If you need a specialist, your primary care physician will need to submit a referral to the insurance company.
When seeing a specialist you will need to see a provider on the network. Even though you have a referral if you chose a doctor off network the insurance company is not required to pay. The appeal of HMO insurance is that as long as you stay on network and follow the policy guidelines it is the cheapest out of pocket plan.
What is a POS plan and how does that work?
Point of Service plans are a hybrid of PPOs and HMOs. Some states like Texas Department of Insurance require HMO providers to offer a Point of Services option. With a POS you will be required to choose a primary care physician but like a PPO you can choose off network for a higher cost. Also if your primary care physician refers you to an off network specialist the insurance company must still pay for the claim.
What should I look at when shopping for health insurance?
You may already know that you want to compare coverage and rates when shopping for health insurance, but what else should you look at?
- Ratings and reviews: You will want to look at a health insurance company’s reputation as well.
- Future needs: You want to consider all aspects of health insurance when choosing a policy for you or your family. If you are planning to have children soon, look at maternity health insurance and well baby care. If you are at high risk for any condition, make sure the policy offers coverage you can afford.
- Overall costs: Compare the type of coverage you will receive to the amount of premiums. Lower premiums are not a good deal if you have less coverage. In addition to health insurance policy premiums, compare co-pays and deductibles.
Finding a PPO health insurance company is easy. Finding a trusted provider with a plan you want and can afford takes a bit more effort. Using the free health insurance quotes tool on this page will give you rates and plans to compare by simply inputting your ZIP code now!