PPOs Provide More Benefits Than HMOs But At More Cost
PPO plans in Arizona are among the most popular types of health insurance coverage for individuals and families. Standing for Preferred Provider Organization, a PPO plan provides robust benefits and a vast network of physicians and other healthcare professionals at reasonable rates. (Although these rates are usually higher than those for a Health Maintenance Organization (HMO) plan.)
At Preferred Insurance, we work with Arizona’s top health insurance companies, including Cigna, Blue Cross Blue Shield of Arizona, UnitedHealthcare, Ambetter, and Bright Health, to offer many PPO options that can meet any needs and budget.
But before you can evaluate PPO plans, you need to understand what a PPO is and how it differs from health insurance coverage under an HMO. Here are the basics about PPO plans in Arizona.
What is a PPO?
A PPO is a type of managed care health insurance coverage. Insurance companies created PPO plans to mirror the cost-saving features of other managed care coverage like HMOs while giving members more flexibility than a typical HMO offers. This combination of low costs and more care options is why PPO’s are extremely popular.
The “preferred provider” in PPO refers to physicians and other providers who are “in-network.” Like HMO plans, PPO plans feature a network of doctors and hospitals that agree to accept lower payments in exchange for participating in the network and thus gaining access to the patients in the insurer’s network.
You receive maximum benefits and lower out-of-pocket costs when you seek treatment from or visit an in-network provider. You can still see out-of-network providers in a PPO plan, but you will pay more.
In a PPO, you can usually visit any provider without the need for a referral from your primary care physician (PCP). This is one of the biggest differences between PPO plans and HMO plans, as HMOs typically require referrals from your PCP.
Cost of PPO Plans in Arizona
Generally, PPO plans cost more than HMO plans; that is the trade-off for more robust benefits and greater options for physicians and providers. There is a much greater chance (but no guarantee) that you can continue to see your current doctor under a PPO plan than under an HMO, but you’ll have a higher monthly premium. For example, according to Healthcare.gov, the average 2021 monthly premium for an HMO is $427 ($5,124 annually), compared to an average monthly premium of $517 for a PPO ($5,628 annually)
Additionally, PPO plans typically have higher deductibles that you will need to satisfy before benefits kick in and the insurer starts paying the costs for your care. You will also likely pay co-pays each time you see a provider.
Pros and Cons of PPO Plans in Arizona
PPO plans in Arizona offer plenty of flexibility, but it comes at a cost, especially compared to plans like HMOs.
If affordability is the most important factor in your choice of healthcare coverage, you don’t have an established relationship with a physician, and you don’t mind having to see a primary care physician before seeing a specialist, choosing an HMO plan may be a good option for you and your family.
However, a PPO is probably a better choice if the following features matter to you when choosing a health care plan:
- The ability to choose almost any doctor, hospital, medical facility, or pharmacy for your healthcare needs
- You want to see an out-of-network physician, such as your current doctor, and want a portion of the costs covered by your plan
- There is not a requirement to get a referral from your primary care doctor before visiting a specialist
Do You Want More Information on PPO Plans In Arizona?
Healthcare is complicated. PPOs and HMOs are just two of many options available when looking for health insurance coverage for yourself and your family. If you are about to begin the process of looking for coverage, the independent Arizona health insurance brokers at Southwest Health Insurance Experts are ready to help.
As a locally owned Arizona small business and group health insurance broker with over three decades of experience, we are committed to answering your questions, addressing your concerns, and providing solutions best suited to your needs and priorities.
To obtain a quote and arrange a free consultation to discuss your small business health insurance needs, contact Southwest Health Insurance Experts today.