With a PPO, you may have:
- A moderate amount of freedom to choose your health care providers — more than an HMO
- Higher out-of-pocket costs than an HMO
- More paperwork than other plans if you see out-of-network providers
- The ability to manage your own health care
- Premium — Your monthly payments are based on the negotiated rates PPOs have with their network providers.
- Deductible — Some PPOs may have a deductible. You may have to pay a higher deductible if you see an out-of-network doctor.
- Copay or coinsurance — A copay is a flat fee, such as $15, you pay when you get care. Coinsurance is when you pay a percent of the charges for care, such as 30%.
- Other costs — If your doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share.
- Paperwork involved. There’s little to no paperwork with a PPO if you see an in-network doctor. If you use an out-of-network provider, you’ll have to pay the provider. Then you have to file a claim to get the PPO plan to pay you back.