EPO, HMO, PPO: Which One Is Right For You?

Posted on: 14 August 2015

New jobs can bring many changes and big adjustments. One of the many changes you'll go through is the switch from your old employer's healthcare insurance to your new employer's insurance. Depending on how big the company is, there could be many health care options. Knowing the difference between an EPO, HMO, and PPO could help you decide type of insurance is best for you.

Preferred Provider Organizations (PPOs)

PPOs have physicians inside a network, but don't require you to stay within the network. Staying inside the network ensures full coverage and also smaller copays. If you want to go to a physician outside the network, you'll have to pay higher copays and some procedures may not be covered at all.

You don't need any referrals to visit a physician within a PPO. PPOs are designed for total patient flexibility, but often require the insured to pay a deductible. As a result, PPOs may not always be the most affordable option.

Health Maintenance Organizations (HMOs)

HMOs are designed to be efficient and cost effective. HMOs keep costs down by limiting patient choices and controlling where the patient receives care. As a patient with an HMO, you'll be assigned a primary care physician. PCPs serve as a main point of care for the patient, who must get all medical treatment through that doctor (except in emergency situations). Patients see their PCPs first and get referrals through their PCPs when the PCP isn't able to provide total care for a condition. All covered care (except emergency care) happens in-network.

Exclusive Provider Organizations (EPOs)

EPOs function like HMOs in that they have a limited number of physicians in their network and don't cover services outside the network (except in emergency situations). However, EPOs don't require their patients to see a primary care physician before seeking treatment from a specialist. Patients can see physicians in-network at any time.

Making the Right Choice

PPOs tend to be the best choice for people who see specialists on a regular basis. People who use PPOs are generally either looking for total convenience or have a condition that requires care from specialists. People who have a limited budget tend to prefer HMOs or EPOs.

For more information and help deciding which plan is right for you, contact your benefits specialist. He or she will be able to go over each plan in detail. After finding out what your primary needs are, he or she can make a recommendation based on your specific needs.

For professional insurance services, contact a company such as Meekins Insurance Services.