A Preferred Provider Organization (PPO) health care plan refers to a health insurance plan that allows its members to have greater flexibility in choosing their doctors. You would have a network of doctors who have contracted with a provider company to provide health care to the members of the plan. A PPO will partially cover costs associated with out-of-network care, but you will pay more if you choose care out of the network.
The PPO network plan is generally a good option if you want more control over your choices and don’t mind paying more for that ability. It would be especially helpful if you travel a lot since you would not need to see a primary care physician. As long as a provider is in your network your care will be covered.
What Is A Primary Care Physician (PCP)?
This is your main doctor that provides comprehensive care. A primary care physician is a doctor, sometimes called a family physician or general practitioner, who is typically your first point of contact for most health issues. The primary care physician, or PCP, can provide preventive care and treatment for minor and chronic illnesses. It is great to have an internal medicine doctor or general practitioner, that way you can have an annual physical exam, which is covered with a $0 copay thanks to the Affordable Care Act. This kind of preventive care is key to keeping healthy. With a PPO, you can choose your primary care physician as long as he/she is in the network.
A Referral Is Not Needed With A PPO Plan
PPO plans do not require you to see in-network doctors and you don’t need referrals. If you choose to see providers outside the network, you will pay more because coverage is lower. If saving money is important, simply choose to stay in-network.
PPO vs HMO Plans
There are a lot of decisions to make when it comes to choosing a health insurance plan. One of the first decisions you will need to make is to decide whether an HMO or a PPO is the best type of plan for you. HMO plans tend to have lower premiums than PPO plans, but PPO plans give you access to a larger network of doctors. With most HMO plans, all of your healthcare services are coordinated by your designated PCP. PPO plans do not require referrals for any services, and you can see any health-care provider without a referral. Since HMOs only allow you to visit in-network providers, it’s likely you’ll never have to file a claim. This is because your insurance company pays the provider directly. With a PPO if you choose an out-of-network provider you may have to pay a doctor for services directly and then file a claim to get reimbursed.
Health Care Options, If You Qualify
The following plans are available if you are eligible due to, income, age, or job layoff:
- Affordable Care Act (ACA) – These plans are designed to give Americans access to reliable health insurance at little or no cost. You may be eligible for this benefit if you are a US citizen, under the age of 65, and making less than $50,000 per year.
- Medicaid – Income eligibility, for example, in 2022 is $13,590 for a single adult person, $27,750 for a family of four, and $46,630 for a family of eight. To calculate for larger households, you need to add $4,720 for each additional person in families with nine or more members.
- Cobra – You have 60 days to enroll in COBRA once your employer-sponsored benefits end. You may even qualify if you quit your job, or your hours were reduced. Other COBRA qualifying events include divorce from or death of the covered employee.
- Medicare – You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security (or the Railroad Retirement Board). Coverage can’t start earlier than the month you turned 65.
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