There are no hard-and-fast rules when it comes to cost-sharing in the various types of health plans. There are three exceptions to the in-network requirement:. For example, going to a hospital outside of the network in an emergency, one may have to pay the medical bills partially or completely out-of-pocket. Therefore, if you already have a doctor that you like, you do not need to switch if you prefer not to. Every EPO has a list of health care providers called a provider network. Was this page helpful? If you want the freedom to schedule appointments directly with specialists, and do not mind having to switch health care providers to one in your EPO network, then EPOs may be a good choice for you. What are your concerns? Languages Add links. For true emergencies.
Understand the main differences between HMO, PPO, and EPO health plans. Out-of-Network Coverage, For medical emergencies only1, Yes, at a higher cost.
EPO stands for "Exclusive Provider Organization" plan. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. You want to receive a much lower negotiated rate with an EPO plan than you would with an HMO or. An EPO health insurance plan can cost much less than an HMO or PPO plan.
EPO Health Plans What Are They ValuePenguin
An Exclusive Provider Organization (EPO) health insurance plan requires you to use the doctors and hospitals within its own network, much like a Health Maintenance Organization (HMO). EPO health insurance.
In exchange for reduced rates of medical services, medical care providers get a steady stream of business.
EPO health plans generally have lower monthly premiums, co-pays, and deductibles than non-EPO options. For true emergencies.
EPO health plans are often more affordable than PPO plans if you choose a doctor or specialist in your local network. With an EPO you won't be required to get a referral before seeing a specialist.
Video: Epo medical coverage How does a Deductible HMO (DHMO) work?- Kaiser Permanente
If you want the freedom to schedule appointments directly with specialists, and do not mind having to switch health care providers to one in your EPO network, then EPOs may be a good choice for you.
What should you know about cost-sharing, referrals, and pre-authorizations?. with an epo (exclusive provider organization), you have a moderate amount of freedom to choose your health care providers. you don't have to get a referral.
But the out-of-network emergency room and physicians do not have a contract with your insurer, which means they aren't required to accept the insurer's payment as payment in full.
EPO Health Insurance What It Is and How It Works
However, you can reduce your costs by choosing an in-network provider who is part of your PPO network. In exchange for reduced rates of medical services, medical care providers get a steady stream of business.
But like a PPO, you're not required to get a referral from your premium care doctor in order to see a specialist.
Video: Epo medical coverage Health Insurance: Accessing Coverage
You can think of that as a trade-off for the fact that the EPO limits you to only using in-network medical providers, whereas PPOs will cover a portion of your costs even if you see out-of-network providers.