Arizona PPO Plans
A Preferred Provider Organization (PPO) is one in which an organized network of doctors, hospitals and other healthcare providers work with a health insurance provider or another third-party administration organization. The providers who are part of the network provide healthcare to members of the administrator’s health insurance program.
How Do PPO Plans Work?
PPO plans work similarly to HMO plans in that both guarantee to cover the costs of healthcare from providers in their networks. However, PPO plans offer much more flexibility, with more freedom in choosing your primary care doctor, and even the option of not having one at all. You may also visit specialist providers without receiving a referral from a primary doctor.
PPO Plans and Out-of-network Costs
Another difference with some PPO plans is that you may visit doctors and specialists who are not part of the PPO network and still receive partial coverage of the costs. In addition, PPO plans tend to have wider network coverage, whereas HMO plans are usually more limited in terms of the geographic location of their providers. Finally, while most HMO plans are available only to people who are part of an employee group, PPO plans can more often be purchased by individuals.
Because consumers have more flexibility with a PPO plan, these plans tend to be more expensive than standard HMO plans that only cover visits to network providers and provide fewer choices for primary care doctors. Monthly premiums for PPO plans are higher than with HMO plans, and co-payment is required for visits to non-network providers.
Wondering if a PPO will cover all of your healthcare needs? Request a quote and speak with an agent.
Arizona PPO Coverage
PPO plans may offer some or all of the following coverage:
- Visits to primary care doctors and specialists in the network
- Diagnostic laboratory tests
- Emergency treatment
- Hospitalization and surgical procedures (both in-patient and out-patient)
- Prescriptions
- Partial reimbursement of the costs of using non-network providers (depending on the plan. Not all PPO plans offer this feature)
Some plans may also offer dental coverage in addition to medical coverage. Unconventional treatments such as acupuncture are typically not covered, and elective surgery, including elective cosmetic surgery, is not covered.
PPO plans are a good option for any individual or family who wants full medical coverage but also prefers a flexible plan that places fewer restrictions on their choice of healthcare provider. This is a particularly good plan for any family with members who travel frequently, as the PPO plan can provide coverage for out-of-state healthcare when necessary, whereas HMO networks are typically limited to in-state providers.
Request a health insurance quote for an Arizona PPO plan today!
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