What is EPO insurance?

EPO is an acronym for a type of health insurance. It’s in the same category as an HMO or PPO, just a different type of coverage.

EPO stands for Exclusive Provider Organization. Members of an EPO health plan can use the doctors & hospitals that are within the EPO network. Although, you cannot go outside the network for health care. No out of network benefits are available.

An EPO may be right for you;

• If you don’t want to get a referral to visit a specialist

• If you want a lower rate than what you’re being offered with an HMO or PPO plan

HMO, PPO or EPO, What’s right for you?

Exclusive Provider Organizations (EPOs), Health Maintenance Organization (HMO) & Preferred Provider Organizations (PPOs) are three health plans that offer distinct benefits. You’re going to want to take the time to understand each type of health plan. That’s the best way to determine if an EPO, HMO or PPO insurance plan is best for your needs. Below we explain each type of plan so you can find what’s best for your lifestyle;

With an HMO (health maintenance organization) you’re required to select a primary care physician (PCP) who will act as a gatekeeper. Your PCP strategically coordinates all of your care and provides for your basic healthcare needs. If you need to see a specialist you’ll need to get a referral from your PCP. The referral will be to a provider within the HMO network. If you want to see a doctor outside of the network or without a referral, you’ll more than likely have out of pockets expenses. There is the exception if it’s a true medical emergency, or you don’t have any other options to choose from. In an HMO you have a local physician network.

In a PPO (preferred provider organization) your health plan is with a preferred network of providers that are in your area. With a PPO you don’t need to choose a primary care physician. You also don’t need a referral to visit a specialist. If it’s a preferred or in-network provider, you’ll only have to pay for a portion of the bill. If you want to see a doctor that’s outside of the preferred network, you’ll have to pay a bigger portion of the bill than you would for an in-network provider. Most of the plans still cover part of the bill. PPO members have access to out of state providers that are still considered in-network.

EPO (exclusive provider organization) plans are a mix of an HMO and a PPO. EPOs offer more flexibility than an HMO. EOPs also come with lower premiums than a PPO. Much like a PPO, you don’t need a referral to see a specialist. Like an HMO, you will be responsible for paying out of pocket to visit a doctor outside your plan’s network. EPOs are a great option if you’d like to see specialists without a PCP referral that’s in your network.

If you still need help determining what’s the best option for you, reach out to one of our agents. They’re all incredibly knowledgeable and extremely nice people! Call us today, we’d love to hear from you 😉