Health insurance can be confusing, with many different plan types using terms that all sound similar. Two options you may come across are PPO and Choice Plus plans. Although they have some overlap, there are key differences between PPO and Choice Plus that impact costs, provider choice, and how you access care.
This comprehensive guide examines PPO and Choice Plus in detail so you can understand how they compare.
What is a PPO Health Insurance Plan?
PPO stands for Preferred Provider Organization. This type of health plan contracts with a network of preferred providers like doctors, hospitals, and pharmacies. As a PPO member, you can see any provider in or out of network, but you’ll pay less when using in-network providers.
Here are some key PPO features:
Nationwide networks: Most PPOs contract with providers across the country, giving you in-network access wherever you are.
Out-of-network coverage: You can see any provider, although visiting out-of-network doctors or facilities costs more.
No referrals required: You can self-refer to any specialist without approval from a primary care provider.
Annual deductible: Most PPOs have a deductible you must meet before coverage kicks in. It ranges from $1,000 to $5,000 typically.
Copays and coinsurance: Once you meet the deductible, you pay a copay or coinsurance for covered services until reaching your out-of-pocket max.
Higher premiums: Premiums are usually higher for PPOs compared to HMOs.
PPOs offer extensive provider choice and coverage flexibility. However, the tradeoff is potentially higher out-of-pocket costs if you use out-of-network or non-preferred providers.
What is a Choice Plus Plan?
Choice Plus is a specific type of PPO plan from UnitedHealthcare. It functions just like a traditional PPO, giving members the choice to see preferred providers for lower costs or out-of-network providers for higher costs.
Some key features of Choice Plus plans include:
Large national network: Access to UnitedHealthcare’s extensive network of over 1.2 million providers and 6,000 hospitals in the U.S.
No referrals needed: You don’t need a referral to see specialists.
Out-of-network coverage: You can go outside the network, but will pay higher deductibles, copays, and coinsurance amounts.
Preventive care covered: In-network preventive care like annual checkups and cancer screenings are covered 100% without having to meet the deductible first.
Pharmacy benefits: Prescription drug coverage is included, often managed by OptumRx or CVS Caremark.
Travel coverage: Emergency care and urgent care are covered when travelling if you use in-network providers.
Virtual visit options: Telehealth through platforms like Teladoc lets you access care by phone or video chat 24/7.
Wellness incentives: Discounts and rewards may be offered for completing health programs like tobacco cessation or weight management.
Choice Plus gives members the flexibility and freedom to direct their own care. There are extra costs involved if you go outside the provider network, but no referrals are needed for specialty care.
PPO vs Choice Plus: How Are They Different?
Now that you understand PPO and Choice Plus basics, let’s directly compare the two plans:
PPOs usually contract with multiple provider networks, while Choice Plus plans specifically use UnitedHealthcare’s network.
Both plan types give you nationwide in-network access when travelling.
Premiums, deductibles, and out-of-pocket costs may be slightly lower for Choice Plus plans that leverage UnitedHealthcare’s negotiated rates.
Member costs for out-of-network care are higher for both options.
Covered services are very similar, encompassing doctor visits, hospitalization, emergency care, surgeries, mental health services, and prescriptions.
Choice Plus plans emphasize virtual visits, preventive care, and wellness incentives.
- Neither PPOs nor Choice Plus require referrals to see specialists. You can self-refer any time.
- For expensive procedures like surgery, plans may require preapproval so benefits aren’t denied. This holds true for both plan types.
PPOs are offered by many insurers, while Choice Plus is exclusive to UnitedHealthcare.
Both plan designs allow open access to providers and facilities.
While Choice Plus plans are a form of PPO, they offer a more defined network and benefit structure through UnitedHealthcare. But the overall flexibility remains similar between the two.
What Are the Pros and Cons of PPO and Choice Plus Plans?
Weighing the advantages and disadvantages of PPO and Choice Plus can help you determine which option may suit your needs better:
- Freedom to choose any provider, in or out of network
- No referrals required for specialists
- Access to large national networks
- Out-of-network coverage
- Premiums are usually higher
- You may incur higher deductibles and coinsurance
- Out-of-network care costs more
- Preapprovals may be needed for expensive procedures
Choice Plus Pros
- Don’t need referrals for specialist visits
- Large national network with over 1 million providers
- Virtual visit options available
- Coverage when travelling
Choice Plus Cons
- Must stay in network for lowest costs
- Out-of-network coverage has higher costs
- Limited to UnitedHealthcare’s provider network
- Preapprovals required for some services
For maximum provider choice, a PPO gives you the ability to seek care outside of defined networks. But if you want access to virtual visits and UnitedHealthcare’s broad network, a Choice Plus plan provides convenience and flexibility.
Who Should Consider a PPO or Choice Plus Plan?
Certain factors can help determine if a PPO or Choice Plus plan is a better fit for your situation:
A PPO may be ideal if you:
- Want open access to providers nationwide
- Have complex health needs requiring specialty care
- Travel frequently and need coverage away from home
- Don’t mind paying higher premiums for greater choice
A Choice Plus plan may be better if you:
- Are comfortable using a defined provider network
- Want lower costs when staying in network
- Value the convenience of telehealth services
- Have a chronic condition needing care coordination
Think about your personal preferences, health status, budget, and any providers you want to continue seeing as you decide between these two plan options.
What Are Some Other Key Differences Between PPO and Choice Plus?
A few other notable differences between traditional PPOs and Choice Plus plans include:
Plan administration – PPOs are offered by many insurance companies while Choice Plus is exclusive to UnitedHealthcare.
Pharmacy benefits – Choice Plus includes OptumRx or CVS Caremark for pharmacy benefits management. Generic and brand prescriptions are covered on all tiers.
Virtual care – Choice Plus plans emphasize virtual provider visits through platforms like Teladoc in addition to urgent care clinics and ERs for acute illness/injury.
Care coordination – Some Choice Plus options provide access to care management programs for chronic conditions like diabetes, COPD, or Congestive Heart Failure.
Wellness incentives – Discounts for gym memberships along with gift cards or merchandise may be offered for completing health programs.
Which Health Plan Network is Best – PPO or Choice Plus?
Whether a PPO or Choice Plus plan network is a better option for you depends on a few key factors:
If provider choice is your top priority: A PPO gives you maximum flexibility to see any doctor or hospital, even if it costs more to go out of network.
If saving money is most important: A Choice Plus plan can be more affordable if you stay in network to take advantage of lower negotiated rates. Out-of-network PPO costs are higher.
If you have complex health needs: With a PPO, you aren’t limited to a single network for specialty access.
If you want enhanced benefits: Choice Plus offers extras like virtual visits, wellness incentives, and chronic disease management that traditional PPOs may not.
If you travel frequently: Both plan types offer in-network nationwide coverage for times when you’re away from home.
For many employees, going with the plan their employer offers most affordably is the best route. Evaluate your total potential costs, provider access, benefits, and convenience factors as you decide which option could be a good fit.
Frequently Asked Questions About PPO
What is an HMO, PPO, HDHP or EPO
What is the difference between UnitedHealthcare choice and choice plus?
Why do doctors prefer PPO?
Is UnitedHealthcare Select Plus a PPO?
What is the difference between a PPO and a POS plan?