The main advantage of an EPO is the balance it offers between cost and flexibility. EPO plans allow direct access to all providers within the network without needing referrals, often at a cost lower than PPOs. The primary disadvantage is the lack of coverage for out-of-network care, which can limit…
EPOs
EPO stands for Exclusive Provider Organization. It’s a type of health plan that features a larger provider network like a PPO, but, unlike a PPO, does not provide out-of-network benefits. EPOs usually do not require a Primary Care Physician or referrals to see a specialist.
What are the typical costs associated with EPO plans?
EPO plans often have higher premiums than HMOs but may be lower than PPOs. They typically involve copayments or coinsurance for services, and you might need to meet a deductible before the plan starts to pay. However, EPO plans can offer cost savings when staying within the network.
Do EPO plans require a Primary Care Physician (PCP) or referrals to see specialists?
Unlike HMO plans, most EPO plans do not require you to choose a Primary Care Physician (PCP) and usually do not require referrals to see specialists. This allows members some level of direct access to specialists within the network without the need for a referral.
How do EPO plans handle out-of-network care?
EPO plans generally do not cover out-of-network care except in emergency situations. If you choose to receive care from a provider outside of the EPO network, you will likely be responsible for the full cost of those services, except in cases of medical emergencies.
What is an Exclusive Provider Organization (EPO) plan?
An Exclusive Provider Organization (EPO) plan is a type of health insurance plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency). EPOs combine the flexibility of PPO plans with the cost-savings of HMO plans. They typically do not…