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In brief, Preferred Provider Organization (called “PPOs”) plans offer you greater freedom in choosing your doctors than do HMO plans. Generally PPO plans cost somewhat more than HMO plans but remain fairly affordable. PPO plans do not offer you as much freedom as a traditional Fee-for-Service plan.
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How PPO Plans Compare
- Fairly Affordable Complete Coverage
- Greater Freedom (than HMO Plans)
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Important Points About PPO Plans
- Like an HMO, PPOs use an approved network of doctors and other healthcare providers (hospitals, specialists, etc.) in order to keep costs down. As a member, you pay less for your healthcare if you use the network.
- Generally, you choose a primary care doctor from the network. This person acts like a traditional family doctor to oversee your care.
- Policies on referrals differ with each plan. Often, if you need specialty care, you do not need a referral from your primary care doctor, as long as you choose a specialist within the network.
- If you see a doctor or specialist outside the network, you will be covered but you will be responsible for a larger portion of the costs.
- Many PPOs don’t cover preventive care, such as routine physicals, immunizations and health screenings. Policies on this vary depending on the specific plan. Check your plan for details.
- Most PPOs require little paperwork on your part as long as you use the network. If you choose to see a non-network doctor, you may need to pay for the services and file a claim form for reimbursement.
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Different Types of PPO Plans
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Copay Plans – These work well for people who make regular doctor’s visits, such as families with young children. You pay a small fee (about $10-$50) for each visit.
- Deductible Plans – These usually work best for people who don’t often need to seek a doctor’s care. Insurance coverage starts after you have paid a certain deductible each year.
You Might Not Want a PPO Plan If...
- You want complete freedom to choose you doctor or specialist.
See the Fee-for-Service plan section.
- You plan to travel.
See the Fee-for-Service section.
- There is not an PPO network convenient to your home or workplace.
See the Fee-for-Service section.
- You can’t afford the PPO premium and need a more bare-bones plan.
See the SDHP and HSA Plans sections.
For details on which PPO plans are offered in your area, please see the Texas-Health-Plans Providers List.
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