Preferred Provider Organization (PPO)
Updated for plan year 2026
In plain terms
A Preferred Provider Organization (PPO) is a plan that gives you the most flexibility in where you get care. You can see specialists without a referral, and you can go out of network and still get partial coverage, though you'll pay more than you would in network. That flexibility usually comes with higher premiums than an HMO or EPO. PPOs suit people who want to keep specific doctors, travel often, or value choice over the lowest monthly cost.
A plain example
Your PPO covers 80 percent in network and 60 percent out of network after the deductible. You keep seeing a trusted specialist who left the network; the plan still pays 60 percent of the allowed amount, leaving you a larger share than before but far from the full bill. No referral was ever required to book the visit.
Why it matters
A PPO buys freedom: any specialist, partial coverage even out of network, no referral gatekeeping. You pay for it in premium. If your doctors are already in a narrower network and you rarely travel, that extra cost may be buying flexibility you won't use.
A common point of confusion
Out-of-network coverage isn't a blank check. PPOs pay a smaller share out of network and base it on an allowed amount, so the provider can still balance-bill you for the difference. The coverage softens the cost, it doesn't cap it.