With a PPO plan, members still have access to a local network of doctors and hospitals. But they also have the flexibility to see any other provider anywhere in America. Not all health plans are available in every county across the country.
Our online search tool makes it easy to find a doctor, specialist or any other network provider near you. Please note: What dual-eligible plans you can get depends on where you live.
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Select your state. States A to - G Skip to. States H to - L Skip to. HMO plans are generally less expensive than PPO plans, with lower monthly payments, making them ideal if your favorite doctors are already in the network, or if you receive most of your care close to home.
Like an HMO, a Preferred Provider Organization is a network of doctors, hospitals and health care providers who agree to provide care at a certain rate. Unlike an HMO, you are not limited to providers who are in-network, though your copay or out-of-pocket cost for out-of-network visits may be higher than for in-network providers. PPO plans typically require higher monthly payments in exchange for increased flexibility.
With a PPO, you do not need to maintain a primary care physician, and can see a different doctor of your choice at any time, including specialists. This also means when you are traveling, you can receive care wherever you are. Additionally, PPO plans offer more options for laboratory service providers. When you need lab work done, you can choose the most convenient location under a PPO network.
If you need a lower monthly fee, consider an HMO plan. If you choose to go outside your network, you'll have higher out-of-pocket costs, and not all services may be covered. If you prefer to have your care coordinated through a single doctor, an HMO plan might be right for you.
Who is this for? HMO stands for health maintenance organization. PPO stands for preferred provider organization. Hence, PPOs were introduced. PPOs rose to popularity among large corporations with many offices spread throughout the country, as a comprehensive PPO plan allows for greater geographical flexibility among the many employees. There are some additional insurance plans that operate in a similar fashion.
An EPO, or Exclusive Provider Organization , functions as an HMO but does not require all care to be funneled through a primary care physician, and no referrals are needed to see a specialist. Just like an HMO, coverage is limited to only doctors within a network. And like a PPO, a POS allows for coverage outside of the network but generally with a referral from the primary care physician. A Fee for Service FFS plan, sometimes called an indemnity plan , allows for the most freedom and flexibility, but also comes with the highest price tag.
FFS patients can choose physicians and specialists at will but face high out-of-pocket expenses and are not always covered for preventive services. This type of plan may require you to pay for all services and then submit a claim to your insurance company for reimbursement. The tradeoff is a lower monthly premium. An HSA collects non-taxed contributions from your paycheck and uses that fund to pay for out-of-pocket health costs such as copays or coinsurance.
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