What Is EPO Insurance?

EPO insurance is a newer variant on older health care plans that combines aspects of more-common HMO and PPO insurance. EPO stands for "exclusive provider organization."

EPO Basics

Someone with EPO insurance has the flexibility to go to doctors and specialists at a discounted rate through the insurance company, although out-of-network services may be costly.

EPO vs. PPO

Preferred provider organizations (PPOs) are similar to EPOs in that patients can visit other medical professionals within the insurer's network, but some PPOs pay for portions of bills incurred with non-network providers. EPOs will not, except in emergencies or with prior approval.

EPO vs. HMO

Health maintenance organizations (HMOs) funnel all medical services through a primary care physician who refers patients to specialists as needed. There can be less flexibility than with EPO insurance.

Advantages

EPO insurance allows patients to visit doctors with less paperwork than with an HMO, and because there are fewer out-of-network benefits, some EPO plans are less expensive than PPO options.

Disadvantages

The lack of medical billing assistance for outside providers in an EPO plan can lead to more out-of-pocket costs than a PPO or HMO in certain situations.

References

• Sample EPO plan
• Health Insurance Consumer Guide