HDHP vs. PPO Health Plans: What's the Difference?
If you're shopping for health insurance coverage, find out if a high-deductible health plan (HDHP) or Preferred Provider Organization (PPO) plan is right for you.
What is an HDHP?
An HDHP is a category of non-traditional health plan that features lower monthly premiums. Because these plans have a higher deductible, that means you'll pay more in out-of-pocket costs before the health insurance company begins sharing the cost (also called "coinsurance").
You can combine an HDHP with a health savings account (HSA). You can use an HSA to help pay for certain medical expenses with funds from your paycheck that are free from federal taxes. Sometimes HDHPs are referred to as "HSA-eligible health plans." Many employers also contribute to HSAs.
There are several types of health insurance plans that have high-deductible options, including:
What is a PPO plan?
A PPO is a type of health insurance plan that typically features a large, national network of providers and health care facilities. With PPO plans, you are not required to have a primary care physician (PCP) or referrals for specialists.
A PPO plan may be considered a high-deductible health plan depending on how its designed. There are PPO plans with high deductibles as well as PPO plans with low deductibles (sometimes called a "traditional PPO" plan).
What are the main differences between HDHP and PPO plans?
The features of HDHP plans and PPO plans depend on the type of plan and how its designed. Learn more about these plans’ costs and coverage.
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HDHP
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PPO
|
|
|---|---|---|
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PCP Required
|
Varies by plan
|
No
|
|
Out-of-Network Coverage
|
Yes, at a higher cost
|
Yes, at a higher cost
|
|
Referrals Needed
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Varies by plan
|
No
|
|
Monthly Premiums
|
Varies by plan
|
High
|
|
Out-of-Pocket Costs
|
High
|
High
|
Should I choose an HDHP or a traditional PPO plan?
There are several factors that may impact your decision on whether to choose a high-deductible health plan or a traditional PPO plan with a low deductible. Here are a few questions to help guide you in your decision-making.
How much medical care do you need?
Think about you and your family's medical needs. Do you typically only need preventive care, or will you require more appointments or treatments? If you need additional medical care, HDHPs may cost you more out of pocket.
How important is it to you to have an HSA?
If you're interested in using an HSA, an HDHP may be right for you. This is especially the case if you're able to make significant contributions to the account or if your employer contributes as well.
Can you afford a high deductible?
If you can afford a high deductible, it may be worth it to get an HDHP in order to have lower monthly premiums.
Do you want flexibility in choosing your providers?
If you're looking for a large network of physicians and facilities, and don't want to have to go through your PCP to coordinate care, a PPO plan may be right for you.
How do I find out if my provider is in network before I enroll?
It’s simple to search for participating health care providers, specialists, hospitals, facilities, and pharmacies that are in network with Cigna HealthcareSM*.
- Visit the Find a Doctor page.
- Choose a provider directory:
- If you're already a Cigna Healthcare customer, log in to myCigna to find in-network providers.
- If you're not a Cigna Healthcare customer yet, select the type of plan you're thinking of enrolling in.
- Once on the provider directory, enter your search location, select the plan type, and enter any relevant search terms in the search box related to type of provider or facility you're looking for.
- Your search results will show the in-network providers based on your search criteria, along with other details that can help when you decide to enroll in your chosen health plan.
Product availability may vary by location and plan type and is subject to change. All health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna Healthcare representative.