CMAA Practice Exam 2025 – Complete Guide for Exam Prep

The Preferred Provider Organization (PPO) is a type of insurance plan that allows patients greater flexibility in choosing their healthcare providers. Under a PPO, individuals can see any doctor or specialist, and do not need a referral to access specialized services. This plan often comes with a network of preferred providers, which means that patients can receive more cost-effective care if they utilize these in-network providers. However, they still retain the freedom to go outside of the network, although this typically results in higher out-of-pocket costs.

This flexibility is a distinguishing feature of PPOs compared to other types of plans. For instance, Health Maintenance Organizations (HMOs) usually require members to select a primary care physician and obtain referrals to see specialists, thereby limiting choices to a specified network. Exclusive Provider Organizations (EPOs) also restrict coverage to network providers without requiring referrals but do not allow for out-of-network care at all. Point of Service (POS) plans blend elements of HMO and PPO structures, allowing patient choice, but they still typically require referrals to see specialists within the network.

By offering the option to choose both in-network and out-of-network providers, PPOs empower patients to have more control over their healthcare decisions, making this option highly appealing for those who