For some people, a PPO (Preferred Provider Organization) is not the best option for healthcare. A PPO allows you to either see the doctors and hospitals within the PPO network or outside of the network and does not require a referral from your primary care physician in order to see a specialist.
But while you technically can obtain care from a doctor outside of the PPO network, you will most likely have to pay more for the service. When paying for services with a PPO, you would generally pay a co-payment for each visit or procedure. The co-payments with a PPO are, as a general rule, higher than other co-payments. In addition, with a PPO you will also pay an annual deductible.
What Are My Options?
If you decide that a PPO isn’t for you, there are other options for a health care plan. HMO, MSA, PSO, and Indemnity Plans are all options should you decide against a PPO.
HMO
HMO stands for Health Maintenance Organization. Members of HMO choose their healthcare providers from a specific list of doctors in that HMO’s network. You will have a primary care physician, who will generally be the first you call or see for any medical concerns. If necessary, your primary care physician will make any needed referrals to a medical specialist within the same HMO network.
It is important that you choose from the network, because if you obtain care without your primary care physician’s referral or get care from a non-network doctor, you might be responsible for paying the entire bill. With some HMOs, you pay nothing when you visit in-network doctors. With other HMOs, you may be required to pay a co-payment for the visit or service. This is usually between $5 and $15. With most HMOs you will not be responsible for paying a deductible, so your out-of-pocket expenses are much lower than that of a PPO.
MSA
An MSA is a Medical Savings Account. These are tax-free accounts that let people save money for medical expenses. The funds contributed to the MSA account can cover any tax-deductible medical expense. There are a variety of these, including chiropractor visits, contacts lenses and eye glasses, doctor visits, and many surgeries, just to name a few. A Medical Savings Account allow those who are self-employed or those whose employees don’t offer insurance to still get tax breaks on their medical expenses. When an employer offers health insurance, the employee doesn’t have to pay taxes on that, just as a person with an MSA wouldn’t pay taxes on their contributions.
MSAs also allow people to choose their own doctors rather than select from a list of approved providers.
PSO
A POS, or Point-of-Service Plan, is a combination of the features of an HMO and a PPO. It allows you to decide whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible or coinsurance charge.
Indemnity Plan
An indemnity plan lets you select visit any medical provider without any kind of referral Most indemnity plans require you to pay a deductible, and once you have paid the deductible, the indemnity plan will pay a percentage of the visit and services, usually 80% while the patient pays 20%.
There are many health-care plans other than PPOs that can provide you with the medical coverage you need. Each plan has its pros and cons, and with a little research you will be able to find a plan that fits your needs.