PPOs and HMOs may be the best-known health plan types, but they’re far from the only ones. Here’s how to tell if an EPO plan is your best bet for coverage.
What Is an EPO?
EPO stands for exclusive provider organization. An EPO allows you some freedom in your provider choices, as long as those providers are in network. As with a PPO, most EPOs won’t require you to select a primary care physician (PCP) or get a referral to see a specialist. EPOs also tend to have lower cost-sharing than PPOs, including coinsurance, deductibles and copays.
What Else Do I Need to Know?
Playing by your EPO’s rules is crucial. Just like with an HMO, if you go outside your network to see a PCP or specialist, the EPO won’t cover your trip. For some services, especially more costly ones, you may need preauthorization. Ensuring that your upcoming service is covered lies fully with you, so it’s important to double-check with your insurer that you’re good to go.
Of course, there are exceptions. Like every Affordable Care Act plan, EPOs have to cover emergency treatment at any hospital regardless of network. But if you need a hospital stay, your insurer may ask you to transfer to an in-network provider.
An EPO is a great way to rein in your health plan costs while also getting the flexibility of a more expensive plan. As long as you remember to stay in your network (even if it’s a little smaller), an EPO plan can be a smart alternative to more common plans.