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The main advantage of the PPO system is that no gateway or primary care physician is required for referrals. PPOs lie between HMOs and pure fee-for-service plans. Your health care is managed but the client is granted a degree of choice in providers. You still pay a monthly premium and in return the network provides PPO insurance service to the client.

One key benefit PPO health plans is that you have the option to choose your healthcare provider. This means that a PPO member does not have to seek care from a physician that is a part of the PPO network, as is the case for HMO plans. However, there is a financial incentive to choose a PPO physician.

If you were to choose a physician from within your PPO network, you may be reimbursed for up to 90% of the care, but only up to 50% for treatment provided by a non-PPO physician. To avoid paying an extra 30% of “out-of-pocket” expenses, many patients choose a PPO network physician.

Another advantage to PPO health insurance is that there is a limit to the amount of out-of-pocket costs that are paid. The usual out-of-pocket cost for an individual who receives care from a PPO provider is limited to $1,200 and $2,100 for a family. These out-of-pocket casts are significantly lower than that of many HMO plans.If an individual or family chooses to be treated by a healthcare provider who is not within the network, these out-of-pocket costs are usually capped at around $2,000 to $3,500. When having PPO health insurance, it pays to use a network physician or healthcare provider.