PPO is not a type of health insurance. It is an abbreviation for Preferred Provider Organization (PPO) which describes the network provider contracting approach associated with whatever health insurance plan you are purchasing. PPO network based health insurance products have dominated the marketplace for many years so it is not unusual for the consumer to blend the two.
After January 1, 2014 you will want to have your health insurance agent check for you, or if you are a "do it yourselfer" do some researching online to determine the type of provider network associated with health plans you may be interested in. The traditional features of PPO plan designs have been to have office visit & prescription copayments, lower deductibles, higher co-insurance levels and lower out-of-pocket financial exposure for using in-network PPO providers while still having coverage for voluntary usage of non-network providers at reduced benefit levels.
PPO plans are the dominant network arrangement in the current health insurance marketplace. However, changes brought about by the Affordable Care Act (ObamaCare), are causing insurance carriers to re-design their products and this does extend to the design of their provider networks. This is especially true of the health insurance products sold in the government health insurance marketplaces where the consumer may encounter multiple network or sub-network type provider arrangements in this environment. For instance, here in Tennessee, the BC/BS plan offers essentially the same insurance products with pricing based on your choice of 3 different PPO networks at 3 different price points. The larger the PPO provider network you choose the higher the insurance premium associated with the product. In fact, the smallest of the 3 BC/BS network options is offered only in the government marketplace.
So, these are words of caution, there are degrees of difference even within what are technically PPO based products these days. Don't just assume that a provider is going to be in-network with an insurance carrier based upon your past experience. Verify with both the insurance carrier and the doctor's office that they are a participating provider.
Also, especially in the individual health insurance marketplace starting in 2014, you will want to be aware of the growing move back to Point-of-Service (POS), Health Maintenance Organization (HMO) and Accountable Care Organization (ACO) based provider delivery systems associated with a growing number of health insurance products. These other variations on the theme apply more stringent guidelines to provider access in a variety of ways (reduced network sizes, gate keeper referral arrangements, sharply reduced or no out-of-network coverage) and introduce entirely new considerations for the consumer.
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After January 1, 2014 you will want to have your health insurance agent check for you, or if you are a "do it yourselfer" do some researching online to determine the type of provider network associated with health plans you may be interested in. The traditional features of PPO plan designs have been to have office visit & prescription copayments, lower deductibles, higher co-insurance levels and lower out-of-pocket financial exposure for using in-network PPO providers while still having coverage for voluntary usage of non-network providers at reduced benefit levels.
PPO plans are the dominant network arrangement in the current health insurance marketplace. However, changes brought about by the Affordable Care Act (ObamaCare), are causing insurance carriers to re-design their products and this does extend to the design of their provider networks. This is especially true of the health insurance products sold in the government health insurance marketplaces where the consumer may encounter multiple network or sub-network type provider arrangements in this environment. For instance, here in Tennessee, the BC/BS plan offers essentially the same insurance products with pricing based on your choice of 3 different PPO networks at 3 different price points. The larger the PPO provider network you choose the higher the insurance premium associated with the product. In fact, the smallest of the 3 BC/BS network options is offered only in the government marketplace.
So, these are words of caution, there are degrees of difference even within what are technically PPO based products these days. Don't just assume that a provider is going to be in-network with an insurance carrier based upon your past experience. Verify with both the insurance carrier and the doctor's office that they are a participating provider.
Also, especially in the individual health insurance marketplace starting in 2014, you will want to be aware of the growing move back to Point-of-Service (POS), Health Maintenance Organization (HMO) and Accountable Care Organization (ACO) based provider delivery systems associated with a growing number of health insurance products. These other variations on the theme apply more stringent guidelines to provider access in a variety of ways (reduced network sizes, gate keeper referral arrangements, sharply reduced or no out-of-network coverage) and introduce entirely new considerations for the consumer.