What is PPO Health Insurance?
PPO health insurance gives you the flexibility to choose your doctors.
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With a PPO, or preferred provider organization, you'll pay less when you go to the doctors in the plan's network. These are the "preferred providers." But unlike other types of health insurance, your plan still pays a share of your medical bills when you go outside the network. PPOs also let you go to specialists without a referral, which can make getting medical care faster.
What is a PPO plan?
A PPO is a type of health insurance network that gives you the ability to see any doctor and have some coverage.
You'll pay a lower amount if you go to a doctor that is in your PPO's network. But if you go outside of the network, your health insurance will still pay for part of your visit.
If you have a PPO, you don't need a primary care doctor like you do with other types of health insurance plans. You can see a specialist without a referral, too, which is a major perk if you have a chronic illness or develop a disease.
What is a provider network?
A provider network is a list of the doctors and hospitals that a plan contracts with to give medical care to its members. These are called "in-network" doctors. Medical offices that aren't contracted with the plan are considered "out-of-network."
How much does a PPO plan cost?
The average cost of a PPO health insurance plan is $662 per month.
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Because PPO plans give you the most flexibility, they have higher rates than other types of plans.
PPO rates vs. other health insurance plans types
Even though PPOs are more expensive, they can save you money overall if you go to the doctor often and need the flexibility to go to doctors outside the plan's network. If you have an HMO, for example, you have to pay for the entire cost of visits to doctors that aren't in your plan's network. Having a PPO means you'll at least have some coverage for out-of-network doctors.
PPO rates by company
Oscar has the cheapest PPO rates from a major insurance company. But the best PPOs for most people come from Blue Cross Blue Shield.
Company | PPO rate | |
|---|---|---|
| Oscar | $471 |
| Ambetter | $491 |
| Blue Cross Blue Shield | $689 | |
| Aetna | $780 |
Average monthly rates for a 40-year-old with a Silver plan.
Not all companies sell PPO plans on HealthCare.gov or state marketplace websites. For example, UnitedHealthcare is the largest health insurance company in the United States, but you can't get a PPO from UnitedHealthcare unless you have insurance through your job.
Cost of PPO plans by state
Where you live impacts how much you'll pay for a PPO. In some states, you can't even get a PPO plan on HealthCare.gov or your state's health insurance marketplace.
Even if you live in a state where PPO plans aren't available for marketplace insurance, you might still have or be able to get a PPO plan through your job.
Best PPO health insurance
The best PPO companies include Blue Cross Blue Shield and Ambetter. But you may be able to get a great PPO from a smaller, regional company in your area.
Best PPO plans for most people: Blue Cross Blue Shield
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Editor's rating
- Average monthly cost: $689
Blue Cross Blue Shield includes most doctors in its PPO networks.
Pros
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Most doctors take BCBS at in-network rates
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PPOs are available in 20 states and D.C.
Cons
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High average rates
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Service varies by location
Blue Cross Blue Shield's PPOs can save you money overall because most doctors and hospitals are in the plan's network. That means you'll pay the lower, in-network rates when you get most medical care, compared to the higher, out-of-pocket rates.
In many states, Blue Cross Blue Shield is the only company that sells PPO plans. For example, Florida Blue is the only company that sells PPO plans in Florida. And in Arizona, you can only get a PPO from Blue Cross Blue Shield of Arizona.
But Blue Cross Blue Shield's PPOs are a bit more expensive than average. And the customer service depends on where you live, because each Blue Cross Blue Shield company operates independently.
Blue Cross Blue Shield sells PPO plans in 20 states and Washington, D.C.
- Alabama
- Alaska
- Arizona
- Arkansas
- Delaware
- Florida
- Hawaii
- Illinois
- Louisiana
- Michigan
- Montana
- Nebraska
- North Carolina
- North Dakota
- Oklahoma
- Pennsylvania
- Rhode Island
- South Carolina
- Washington, D.C.
- West Virginia
- Wyoming
Best cheap PPO plans: Ambetter
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Editor's rating
- Average monthly cost: $491
Ambetter has cheap rates for its PPO plans.
Pros
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Cheap PPO rates
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Good extra perks
Cons
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PPOs only available in two states
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Can be hard to find in-network doctors
Ambetter has cheap rates for PPOs, which makes it a good option if you're on a budget but still want a flexible health insurance plan. Its rates aren't as cheap as Oscar, but it has better customer service.
However, Ambetter's customer service still isn't good, although it's better than Oscar's. If you live in Arkansas or Oklahoma, where Ambetter sells PPOs, Blue Cross Blue Shield is a better option. It's more expensive, but it comes with far better customer service.
Ambetter has also had issues with its doctor directory. Customers have reported that the list of in-network doctors isn't correct. While PPOs let you go to out-of-network doctors and will still pay for some of your bills, it's cheaper to go to in-network offices. It could be an issue if you think an office is in-network and it isn't, because then you'll have to pay more than you expect.
Ambetter only sells PPO plans in Arkansas and Oklahoma.
What are the differences between PPOs and other networks?
Along with where you get care, different networks also determine how much you’ll pay for medical services. Understanding the different network types can help you refine your search when you're shopping for health insurance.
The two main types of health insurance networks are PPOs and HMOs, or health maintenance organizations.
HMO | PPO | |
|---|---|---|
| Cost | Cheaper rates | Higher rates |
| Primary care doctor required? | Yes | No |
| Referral needed to see a specialist? | Yes | No |
| Out-of-network care available? | No | Yes |
With an HMO, you need a primary care doctor. If you want to go to a specialist, you have to first see your primary doctor and get a referral. You also have to go to in-network doctors if you want your plan to cover anything. If you go outside the network, you have to pay the full cost for your visit.
Because HMOs restrict you to a network of doctors and give you less flexibility, they have a lower monthly rate compared to PPOs.
Like HMOs, EPOs, or exclusive provider organizations, don't cover any medical care if you go outside the plan's network.
EPO | PPO | |
|---|---|---|
| Cost | Cheaper rates | Higher rates |
| Primary care doctor required? | No | No |
| Referral needed to see a specialist? | No, but the specialist must be in-network | No |
| Out-of-network care available? | No | Yes |
However, you can go to a specialist without a referral if the specialist is within the network. EPOs are usually cheaper than PPOs, but they're not very common.
Point of service (POS) policies are similar to PPOs because they let you get care outside the plan's network and still have some coverage.
POS | PPO | |
|---|---|---|
| Cost | Cheaper rates | Higher rates |
| Primary care doctor required? | Yes | No |
| Referral needed to see a specialist? | Yes | No |
| Out-of-network care available? | Yes | Yes |
But like an HMO, you need a primary care doctor with a POS plan, and you have to get a referral to see a specialist.
Frequently asked questions
What does PPO mean in health insurance?
PPO stands for "preferred provider organization." PPOs are a type of health insurance plan that lets you go to any doctor and still have some coverage. If a doctor isn't in the plan's network, you'll pay more for your visit, but your plan will still pay something toward your medical bills. You can also see a specialist without a referral if you have a PPO, and you don't need to have a primary care doctor.
What is the downside to a PPO plan?
PPOs tend to be more expensive than other plan networks because they give you the flexibility to go to both in- and out-of-network doctors and still have some coverage. If you go to a doctor that isn't in the network, your plan will still pay for some of your medical bills, but you'll pay more than if you go to an in-network doctor.
Which is better, a HMO or PPO?
An HMO is a better option if you're looking for a cheap plan, but remember that you have to use in-network doctors to have coverage. A PPO is probably better for most people, because it gives you the freedom to go to any doctor and still have some coverage. But PPOs cost more than HMOs, so they aren't the best if you're on a budget.
Methodology
ValuePenguin sourced its 2025 health insurance rates from Centers for Medicare & Medicaid Services (CMS) government website public use files (PUFs). Rates are averages for a 40-year-old with a Silver plan and with each type of health insurance network mentioned.
Editorial note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.