What Is a PPO?

Jenifer Dorsey
2018-11-29 February 23rd, 2016 |
Read time: 8 minutes

If you’re in between Obamacare plans and have been shopping for temporary benefits, you may have encountered short-term health insurance products with PPO in the name or description. What does this mean, and how are these plans different than an Obamacare plan PPO or even other short-term plans?

Let’s break it down.

1.  What is a PPO?

PPO stands for preferred provider organization, and a preferred provider organization is a type of health insurance plan network in which doctors, hospitals and other healthcare providers contract with a health insurance company or third-party administrator to provide healthcare at a reduced rate to their clients.

Unlike HMOs (i.e., health maintenance organizations), which typically require you to seek care from contracted providers, PPOs typically allow you to chose in- or out-of-network providers. Whereas an HMO is unlikely to cover any out-of-network care that is not an emergency, a PPO plan often covers a certain percentage of out-of-network care regardless of whether or not it is an emergency.

However, if you are insured by a PPO plan and receive care from out-of-network providers, you will typically pay more out of pocket. Conversely, you will generally pay less when you receive care from providers that participate in your PPO plan’s network.

2. What is short-term health insurance?

Short-term health insurance is what consumers often call short-term medical, or STM, plans. A short-term health plan provides temporary benefits for 30 to 364 days, depending on your state. You pick the policy length you need when you apply and enroll.

Short-term plans are not ACA compliant. That means they are not a replacement for Obamacare coverage and will not prevent you from owing a tax penalty, and you may not qualify for one if you have a preexisting health condition.

However, when you are in between Obamacare plans, short-term coverage can offer a range of benefits to help pay for unexpected medical care.

3. STM + PPO – What happens when you put them together?

You get a short-term PPO plan. So, what does that actually mean?

A benefit of many short-term health insurance plans is that they are designed without networks, which means you can receive care from the doctors and hospitals you prefer. Sometimes these plans partner with national provider networks, and these partnerships provide you with access to discounts from select doctors and hospitals.

However, sometimes consumers want access to networks and the money-saving features PPO coverage can offer. A short-term PPO, while not the same as the ACA-compliant plans you purchase from the state and federal exchanges or in the private market, is designed with some similarities to major medical PPOs. These features can help you lower your out-of-pocket healthcare costs and include:

  • Rx copays
  • Office visit copays
  • Discounts on healthcare received from network providers

Short-term PPO plans sold through healthedeals.com come in several plan designs, and you can pick your in-network deductible as well as your coinsurance percentage and out-of-pocket amounts. Some short-term plans, including Connect Net from The IHC Group, which is available in certain states through healthedeals.com, even include a few preventive care benefits.

How can I get a short-term PPO or traditional short-term plan?

Call the number at the top of your screen to speak with a certified health insurance agent who can answer your questions and assist you in finding a short-term health plan that meets your personal needs.

Begin Coverage in 3 Easy Steps!

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Step 1: Get a quote within seconds
Step 2: Compare multiple plans
Step 3: Finish application online

References:

HealthCare.gov. “Preferred Provider Organization.” https://www.healthcare.gov/glossary/preferred-provider-organization-PPO/

U.S. Department of Health and Human Services. “What You Should Know About Provider Networks.” Revised September 2015. https://marketplace.cms.gov/outreach-and-education/what-you-should-know-provider-networks.pdf

Wikipedia. “Preferred Provider Organization. https://en.wikipedia.org/wiki/Preferred_provider_organization

Originally Published On February 23rd, 2016