The most affordable health insurance plans are typically those that offer the least amount of options. An Exclusive Provider Organization (EPO) plan is one such plan that has limited flexibility but often costs the least.
When you enroll in an EPO health insurance plan, you are only allowed to seek care from providers within the plan’s network. The same can be said for health care facilities; you are required to make appointments at facilities that work with your plan. Some EPO plans require you to choose a primary care provider (PCP), while others afford you the freedom to see any doctor within the network.
EPO health insurance does not cover the cost of visiting an out-of-network provider. The only exception to this is for medical emergencies. If you seek care from an out-of-network doctor, you will be responsible for paying all the costs associated with the visit. This can add up quickly, which is why EPO plans are not always recommended for folks who require frequent medical care.
Because of these limitations, EPO health insurance plans are typically best suited for those who do not require frequent or advanced medical care. The ideal candidate for an EPO plan is someone who wants basic, low-cost coverage, who does not want referrals for services and who is satisfied seeking treatment from a limited pool of providers.
When comparing HMO vs EPO plans, note that both these insurance options require you to choose a primary care provider (PCP) from within a network of doctors. However, the network for EPO plans is typically smaller and more limited in availability.
EPO health insurance typically has the lowest premium rates among all types of health care plans. However, there is typically a deductible for in-network care, which varies depending on your specific plan.
If you need to seek care from a doctor or specialist outside of the plan’s network, EPO health insurance will not pay for any of the costs unless it is a medical emergency. This is one of the reasons why EPO plans are better suited for individuals who do not anticipate needing frequent or complex care.One of the differences between EPO health insurance and POS plans is the need for a referral. EPO plans do not require you to get a referral from a primary care for services, which is beneficial if you already know what you need or want. However, your plan’s network may not have a diverse group of providers to choose from, which can limit your options.