EPO Versus HMO Health Insurance
Most health insurance plans fall into one of three types: HMO, PPO and EPO. Understanding the difference can help consumers trying to choose the best option.
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EPO Basics
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An EPO plan has a network of doctors and medical specialists who are available at a discounted rate. Outside of that network, procedures and tests are billed in whole to the insured.
HMO Basics
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The consumer chooses a primary care physician for an HMO plan. Along with general checkups, the physician refers the patient to specialists as needed.
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Advantages
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EPOs can be a more affordable choice, and patients can choose among providers in their network. HMOs simplify things by routing medical issues through the physician.
Disadvantages
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If a provider is not in an EPO network, the patient may be responsible for all costs incurred. HMOs offer fewer choices among physicians once a primary care provider is chosen.
Alternatives
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Preferred Provider Organizations (PPOs) offer in- and out-of-network benefits, but may be more costly than similar EPO and HMO choices.
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