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Preferred Provider Organization
With a Preferred Provider Organization (PPO), you pay less for care when you use in-network providers – doctors, hospitals, and pharmacies that are part of the PPO network.
The PPO plan is a good choice for people who are willing to have larger paycheck deductions in exchange for lower out-of-pocket costs. |
How a PPO Works
The plan also provides coverage when you go to out-of-network providers, but you’ll pay more. This plan doesn’t require referrals.
- Your deductible might be lower. With a traditional PPO plan, the deductible is usually lower than a PPO with a spending account.
- You can choose any provider. With a PPO plan, you decide whether you want to use in-network doctors or not. If you “step outside the network,” your copayment, deductible, and coinsurance costs will be higher – sometimes significantly higher.
- The out-of-pocket limit gives you peace of mind. A PPO plan limits the amount of money you’ll spend within the plan year. If you reach this limit, called the “out-of-pocket maximum,” the plan pays 100 percent of additional covered expenses during the plan year. You continue to pay copayments.
PPO out-of-pocket costs
With all PPO plans, your out-of-pocket costs may include:
- Copayments – A fixed fee you pay when you see a doctor, have a prescription filled, or are admitted to the hospital. Copayments are generally lower for services from primary care doctors than for specialists.
- Deductible – The amount you pay toward certain medical expenses before your plan starts paying a share of the costs. PPO plans generally have separate deductibles and out-of-pocket limits for in-network and out-of-network providers.
- Coinsurance – The percentage of costs you pay after you’ve met the deductible. The plan always pays a higher percentage when you use in-network providers.
The Out-of-Network Cost Impact
When deciding where to go for your care, it’s important to understand how the provider you choose to see can greatly affect your out-of-pocket costs.
Understanding the Out-of-Network Cost Impact
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Use this side-by-side chart to compare Humana's various health plans.
Use our online provider directory to find out if your doctor participates in Humana’s network. |
Log in to MyHumana, your secured personal page, to view details about your plan. |
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