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What’s a PPO?

PPO stands for preferred provider organization.

I have a PPO. I pay more, but can choose the specialists I want.

– Tony

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PPO basics

In a PPO you get most of your health care from a network of providers, just as you do in an HMO. But you can choose to go outside of the network and pay more. Some Medicare Advantage plans are PPOs, for people with Medicare. There are also Medicare Advantage HMOs.

Primary care doctor: You can have a primary care doctor in a PPO, and it is often advisable to have one, but you do not have to. You can go to a specialist and get other services without seeing a primary care doctor first.

Networks and medical groups: Like HMOs, PPOs have a network of doctors and other providers. However, you can choose to see providers who are not in the network. You usually pay a higher cost to see these providers.

Why would I choose a PPO?

  • You have a doctor you like and you want to keep this doctor.
  • You want to see specialists and other providers without having to get referrals and pre-approval first.
  • You want the freedom to see providers who are not in the network.
  • You are confident that you can manage your own care.
  • You do not want a primary care doctor.

Why would I NOT choose a PPO?

  • You don’t want the extra responsibility of managing your own care.
  • PPOs are not as closely regulated by the government as HMOs.
  • You do not want to pay the higher costs of a PPO.
  • You do not want to get bills from providers.

More about PPOs

The Department of Managed Health Care regulates Blue Cross/Blue Shield PPOs. The Department of Insurance regulates other PPOs.

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