Preferred provider organizations (PPOs) generally offer a wider choice of providers than HMOs. Premiums may be similar to or slightly higher than HMOs, and out-of-pocket costs are generally higher and more complicated than those for HMOs. PPOs allow participants to venture out of the provider network at their discretion and do not require a referral from a primary care physician. However, straying from the PPO network means that participants may pay a greater share of the costs.

What is covered? 

Usually comprehensive

Whom can you see? 

Any doctor, but benefits reduced for services outside the network.

Cost-sharing at time of service: 

Typically have copayments between $10 and $50, co-insurance up to a deductible.

Monthly premium*: 

Depends on cost-sharing: High deductibles usually mean lower premiums and low deductibles mean higher monthly premiums. The national montly average is roughly $600. 


Good option if choice of providers is important to employees. Employees should be willing to assume responsibility for some administrative duties (such as obtaining referrals or submitting claims).

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