A PPO (Preferred Provider Organization) plan is a type of Medicare Advantage Plan (Part C) that is offered through a private insurance company. It’s the most common way for people to get insurance after insurance provided by their employer. PPO plans are the most favored insurance plans for people who are self-employed, or are not satisfied with the insurance plan offered through their place of employment. These plans can range from complete health insurance policies down to supplemental plans that cover vision care or some other specific aspect of health and wellness.
PPO plans are built on the idea that you’re going to stay within a network of doctors. These medical professionals are not your only options; it’s possible to see doctors outside of your network. Depending on the plan, it’s even possible that a portion of your visit will still be covered if you seek a doctor outside of your insurance company’s network; however, you can expect to pay a lot more. When you stick to a doctor within the network, you pay much less in co-pays and have access to a wider range of procedures at much lower cost.
Out of network procedures and appointments are the main flaw in PPO plans. If your network doesn’t include a specialist in the event that you have a serious medical condition arise, you could be forced to pay out of pocket (or pay drastically higher co-pays and deductibles) to see a specialist in that area.
Despite that flaw, PPO plans remain popular as they put the choice of network, plan, and policy in the hands of the person being insured and not necessarily in the hands of their employer. This freedom and relative flexibility makes PPO plans a solid choice for people of any age and general wellness level.