A PPO, or Preferred Provider Organization, is the plan type most people mean when they say they want "good" health insurance. It usually offers the most freedom: no referrals, a broad network and some coverage out of network. But two PPO plans can be very different. Here's how to compare them.
PPO vs. HMO vs. EPO
| PPO | EPO | HMO | |
|---|---|---|---|
| Referrals to see specialists | Not required | Usually not required | Usually required |
| Out-of-network coverage | Partial, except emergencies | Emergencies only | Emergencies only |
| Network size | Typically largest | Medium | Often smallest |
| Premium | Typically highest, unless you're healthy and qualify for a private underwritten PPO | Medium | Often lowest |
The PPO comparison checklist
- Which network does it actually use? Carriers run several networks. Confirm the exact network name, not just the carrier.
- Are your doctors and hospital in it? Search the plan's provider directory, then call the office to confirm they accept that specific plan.
- Is it national? If you travel, have children at college or spend part of the year elsewhere, check coverage outside Florida.
- How does out-of-network coverage work? Look for a separate out-of-network deductible and out-of-pocket maximum, and know that out-of-network providers may bill you the difference between their charge and what the plan pays.
- What's the total yearly cost? Add the premium to the deductible, copays, coinsurance and the in-network out-of-pocket maximum.
- How are prescriptions covered? Check that your medications are on the formulary and at what tier.
Surprise bills
The federal No Surprises Act protects you from most surprise bills for emergency care and for certain out-of-network providers at in-network hospitals and facilities. It doesn't replace checking the network for planned care, but it is an important protection.
Private PPO plans
Many ACA plans in Florida are HMO or EPO plans. Many private plans use PPO networks, which can be the way to keep the doctors you already use if you qualify medically. See private PPO health insurance or family health insurance.
Sources
General information only, not tax, legal or medical advice. Plan availability, benefits, networks and pricing vary by carrier, state, county and eligibility. Stratton Advisory Group is an independent agency and is not affiliated with any insurance carrier or government agency.