When it comes to selecting a health insurance plan, there are many factors to consider. One of the most important is the type of network offered by your carrier. Different networks offer different services at different costs, so understanding what each one offers will help you make an informed decision. Let’s take a look at the differences between PPO, HMO and EPO health insurance plans.
PPO (Preferred Provider Organization) Network
The PPO network is the most popular type of insurance plan. With a PPO plan, you have access to both in-network and out-of-network providers. The in-network providers have agreed to discounted fees while the out-of-network providers may charge more for their services. You also don’t need a referral from your primary care physician when seeing a specialist within this network—which can be beneficial if you require specific services or treatments. Additionally, with a PPO plan, you can usually visit any doctor without having to select one as your primary care provider (PCP). However, you may still need referrals for certain procedures or treatments depending on your policy.
HMO (Health Maintenance Organization) Network
HMO plans typically come with lower premiums than PPO plans. With an HMO plan, you must select a PCP from within the network and get referrals from them to see any specialists within that same network. You also cannot go outside of the network unless it is an emergency—in which case, you will likely face higher out-of-pocket costs for those services or treatments provided by providers not listed in its directory. Additionally, some HMO policies do not cover prescription drugs and other medical expenses outside of their own approved list of medications and treatments.
EPO (Exclusive Provider Organization) Network
An EPO plan combines elements of both HMO and PPO plans by offering members access to an exclusive list of doctors and hospitals that they can choose from without needing referrals or prior authorization—like in a PPO plan—but without having to pay additional fees for going out of network like with a traditional PPO plan. While these plans often have low premiums like an HMO plan, they also usually come with high deductibles and co-pays which means members could end up paying more out of pocket than with other types of plans if they need extensive medical care or numerous doctor visits throughout the year.
When it comes time to select a health insurance policy, it’s important to understand all your options before making a decision on which one is best suited for you and your family’s needs.
Understanding the differences between these three networks—PPO, HMO & EPO—will help ensure that you get coverage that meets all your needs while still being cost-effective! Choosing wisely will save you money AND provide peace of mind knowing that you’re covered should something unforeseen happen!
For more information on picking the right insurance on Healthcare.gov marketplace see:
Navigating Marketplace Health Insurance: 5 Tips For Picking The Right Individual Health Plan