Arizona Health Insurance Practice Exam

What is a primary benefit of a PPO plan compared to an HMO?

1. Lower premiums

2. More flexibility in choosing healthcare providers

3. Fewer out-of-pocket costs

4. Mandatory referrals for specialists

The correct answer is: More flexibility in choosing healthcare providers

A primary benefit of a PPO (Preferred Provider Organization) plan compared to an HMO (Health Maintenance Organization) plan is indeed the increased flexibility in choosing healthcare providers. In a PPO plan, members are not restricted to a network of doctors and can see any healthcare provider without a referral, which is a significant advantage for those who wish to access specialists directly or prefer to have a wider selection of physicians and facilities. This flexibility allows members to seek care from out-of-network providers, although it may come with higher out-of-pocket costs compared to in-network visits. In contrast, HMO plans typically require members to choose a primary care physician (PCP) and obtain referrals to see specialists. This can limit access to care and potentially delay treatment, as members must go through their PCP for any specialized service. Furthermore, PPO plans generally do not impose restrictions on out-of-network providers, giving members the option to pursue care beyond a designated network if they choose, enhancing their overall control over healthcare decisions and care management.