A PPO plan offers the freedom to receive care from any in- or out-of-network doctor, specialist or hospital without a referral. You have a deductible to meet and once the deductible is met, coinsurance (or the cost share between you and the carrier) kicks in.
The types of medical services that accumulate towards your deductible are inpatient hospital stays, outpatient surgeries, labs (blood work) and x-rays (MRIs, PET scans, CT scans, etc.). If you go to the doctor, see a specialist, utilize the ER or take a prescription drug, you’ll pay a copay for those specific services. Copays do not accumulate towards your deductible, but they do accumulate towards your overall out-of-pocket maximum.
With this plan, you must meet a $3,000 deductible (individual) before the insurance starts to pay. Once met, the insurance will cover 80% of the claim totals. You continue to pay the remaining 20% of the charges until $6,000 is met on an individual. After that, the insurance covers 100%.