EPO Versus HMO Health Insurance

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The Difference Between POS & HMO Health Insurance....5

EPO stands for "Exclusive Provider Organization" and HMO stands for "Health Maintenance Organization." Learn about EPO versus HMO health insurance with help from the president of The Stratford Financial Group, Inc. in this free video clip.

Part of the Video Series: Health Insurance & More
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Video Transcript

Hello, I'm Jeffrey Ingalls; President of Stratford Financial Group and Stratford Employer Services in Wayne, New Jersey. And right now we're going to talk about EPO versus HMO health insurance. It's important to know what these two terms stand for. EPO stands for Exclusive Provider Organization whereas HMO stands for Health Maintenance Organization. Both plans refer to manage care plans and normally utilize a local or national network of participating providers. Both plans are designed to provide in-network benefits only. An easy way to make comparison is to understand that an EPO is to a PPO plan, when an HMO plan is to a point of service plan. An EPO never requires that you select a primary care physician nor does it require that you receive a referral to obtain in-network specialty care. Under an HMO, unless provided in an open access or direct access format, will require you to select the PCP or primary care physician and will also require you to receive a referral from that PCP or primary care physician in order to obtain in-network specialty care. Both plans utilize a network of participating providers who have agreed to a listing of contracted negotiated discounted fees. Both plans do not include out of network care or out of network coverage except in the case of a bonafide emergency. When looking for the listing of the participating doctors in either an EPO or an HMO, it's a good idea to search the insurance company's website where you can have an online searchable provider directory. My name is Jeffrey Ingalls. I'm the President of Stratford Financial Group and Stratford Employer Services in Wayne, New Jersey. We can be found online at www.stratfordlink.com and you just watched EPO versus HMO health insurance. Thank you.

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