After offering health insurance to both employers, employees, and individual purchasers, I have noticed that many people do not know the fundamentals of health insurance. This quick blog will help you better understand the differences between PPO plans, HMO plans, and EPO plans.
PPO plans have been a staple in the industry for many years and people see them as the largest health insurance options on the market. With a PPO plan you have access to a large network of doctors. In addition to this network, you can also visit doctors outside of your network and your health insurance carrier will will pay for up to 50% of your costs. Finally, with a PPO plan you do not need a primary care physician to tell you which doctor to see next. This gives you your flexibility and the freedom to choose which doctor is best for you.
An HMO plan is very different than a PPO plan. With an HMO plan you must first see a primary care physician that is within your network before you can see any other doctor that is available to you. That primary care physician will dictate your care and will select who and what is your next step after that first visit. With an HMO plan you do not have out-of-network benefits, meaning that if you visit a doctor outside of your carrier you will pay 100% of the costs.
Your third option is called, an EPO plan. This EPO plan takes the best of both a PPO and an HMO creating a new type of health insurance plan. With an EPO you do not need to visit a primary care physician first, you can select which doctor within your network is best for you. However, you do not have access to doctors outside of your network meaning your carrier will not pay the 50% they did with a PPO plan.
EPO plans are awesome. Having to visit a primary care physician can be very frustrating and time-consuming with your traditional HMO plan. However, with this EPO you are able to visit any doctor in your network at any time. It is easier to stay within network with your EPO plan because you know that you don't have any coverage through your carrier if you visit outside of the network. This is helpful when trying to reduce your out-of-pocket costs. And remember you can always visit any doctor you want you just simply have to pay out of your own pocket.