How to Choose a PPO

A preferred provider organization (PPO) offers its members a network of physicians and hospitals to choose from. Unlike most HMOs, PPOs give you the option of using physicians outside your plan while still receiving coverage. Consider the following information when choosing a PPO.

Difficulty: Moderate

Instructions

1. Make a list of services you think you will require from a plan. This could include physical exams, care from specialists, vision care, mental health services or family planning services.

2. Have the PPOs you are considering send you a coverage booklet. Carefully read the services being offered and see if they cover the items on your list. Pay close attention to what is not being offered as well.

3. Find out the number of doctors the plan offers and where they are located.

4. Inquire about the number of hospitals in the network, and where the nearest one is to you.

5. Ask how the PPO covers emergency care. Will it cover you if you should require care at a hospital outside of the network?

6. Look at costs such as your monthly premium (set amount you pay each month to belong to the PPO) and any co-payment for doctor's visits or other services (set amount you pay each time a service is provided for you - this is separate from your monthly premiums).

7. Determine how much extra you will have to pay if you receive care from a physician outside the network. What will your deductible (amount you pay for going outside the network) be and is there a limit to how much you will have to spend out of pocket?

8. Talk to your employer and coworkers about the PPOs you are considering, and ask what their experiences have been, if any, with the PPO.

Tips & Warnings

• Think about any upcoming life changes such as retirement or starting a family when you are considering a PPO. Will it cover these changes?
• Contact agencies that review health plans for quality of care, such as the National Committee for Quality Assurance (NCQA), to see what kind of accreditation (seal of approval) rating the plan has received.
• Under a new law called the Health Insurance Portability and Accountability Act, health plans are now required to immediately cover pre-existing conditions if you have been insured for the previous 12 months. Before the law, health plans had a waiting period before they would cover a pre-existing condition.

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