What Is a PPO, and Who Is It Good For?

If an HMO is a home base, a PPO is an open road. A PPO gives you more freedom to choose your doctors. But that freedom usually costs more. Let's look at how it works.

How a PPO works

PPO stands for Preferred Provider Organization. Here are the main rules:

• You can see any doctor in the network. You don't need to pick one main doctor.

• No referrals needed. Want to see a specialist? You can book the visit yourself.

• You can go outside the network. Your plan will still pay some of the cost. But you'll pay more than you would in-network.

Why people like PPOs

• More choice. PPO networks are often bigger, and you can see out-of-network doctors too.

• Fewer steps. You can go straight to a specialist.

• Care away from home. PPOs often work better if you travel or have family in other states.

The trade-offs

• Higher monthly cost. PPOs usually have higher premiums than HMOs.

• Out-of-network still costs more. You'll often have a separate, bigger deductible for out-of-network care.

Meet Priya

Priya is 45. She has a heart condition and sees a heart doctor she trusts. She also has a son in college two states away. Priya chose a PPO. She can keep seeing her heart doctor without a referral. And when her son got sick at school, he could see a doctor near campus.

Priya pays more each month than she would for an HMO. But for her family, the extra freedom is worth it.

A PPO might be a good fit if you:

• Have doctors or specialists you don't want to give up

• Travel a lot or have family members in other states

• Are OK paying more each month for more choice

A PPO might not be a good fit if you:

• Want the lowest monthly cost

• Are healthy and rarely see a doctor

• Are happy with the doctors in a cheaper plan's network

Key takeaways

• A PPO lets you see specialists without a referral.

• You can go out-of-network, but you'll pay more.

• More freedom usually means a higher monthly cost.