Are PPO plans available everywhere?

No. PPO availability varies by state, county, and carrier, and changes from year to year. In some areas HMO or EPO designs dominate the individual market.

Do PPO plans cost more?

PPO plans often carry higher premiums than narrower-network designs, but total cost depends on the deductible, your expected care, and whether your providers are in network.

Coverage Guide

PPO Health Insurance Plans

A PPO — preferred provider organization — is a plan structure built around a network of contracted providers, usually with some level of out-of-network benefits. PPO plans are often sought by people who want flexibility in choosing doctors.

Check My Options Speak With an Advisor

How a PPO Plan Is Structured

PPO plans contract with a network of doctors, specialists, and facilities at negotiated rates. Care received in network costs less. Many PPO plans also pay a reduced share for out-of-network care, though your costs are typically higher and balance billing may apply.

Most PPO designs do not require a referral to see a specialist, which is a common reason people prefer them.

Who Tends to Look at PPO Plans

People who want to keep an existing specialist or hospital system
Households that travel or split time between states
Self-employed professionals who value provider flexibility
Anyone managing an ongoing condition with an established care team

What to Confirm Before Enrolling

That your providers are in network for that specific plan, not just that carrier
The out-of-network deductible and coinsurance, which are usually separate
Whether prior authorization applies to planned procedures
PPO availability in your state, which varies by carrier and year

Common Questions

Ready to Review Your Health Coverage Options?

Get personal guidance and compare options that may fit your needs, budget, doctors, prescriptions, and coverage goals.

Check My Options Speak With an Advisor Schedule a Consultation