What is the difference between a HMO and an EPO? (2023)

Asked by: Travis Ernser|Last update: January 31, 2023

Score: 4.7/5 (30 votes)

An Exclusive Provider Organization (EPO) is a lesser-known plan type. Like HMOs, EPOs cover only in-network care, but networks are generally larger than for HMOs. They may or may not require referrals from a primary care physician. Premiums are higher than HMOs, but lower than PPOs.

Is an EPO better than an HMO?

EPO health insurance often has lower premiums than HMOs. However, HMOs have a bigger network of healthcare providers which more than makes up for it. You may also want to consider your location when choosing a health insurance plan. EPOs are better suited for rural areas than HMOs.

Is EPO the same as PPO or HMO?

EPO plans offer a larger network than an HMO plan and typically do not have the out-of-network benefits of PPO plans. Generally, EPO plans cost more than an HMO, but less than a PPO.

Is a EPO or PPO better?

A PPO plan gives you more flexibility than an EPO by allowing you to attend out-of-network providers. On the other hand, an EPO will typically have lower monthly premiums than a PPO. But, if you're considering an EPO, you should check approved in-network providers in your area before you decide.

Is an EPO worse than a PPO?

An EPO is usually more pocket-friendly than a PPO plan. However, if you choose to get care outside of your plan's network, it usually will not be covered (except in an emergency).

23 related questions found

What are the pros and cons of an EPO?

Pros and Cons of an EPO

Low monthly premiums: EPOs tend to have lower premiums than Preferred Provider Organizations (PPOs), though they're higher than Health Maintenance Organization (HMO) premiums. Large networks: They generally offer a wider selection of care providers than HMOs.

Do doctors prefer HMO or PPO?

PPOs Usually Win on Choice and Flexibility

If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.

Why is EPO more expensive than PPO?

The cost of a PPO plan will also increase the more often you take advantage of that freedom, as you are expected to cover a higher proportion of the costs incurred in seeing healthcare providers from outside the network. EPOs are usually cheaper due to the restrictions on which healthcare providers you can visit.

What is EPO health plan?

A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency).

Does EPO have out of network benefits?

With an EPO, you can use the doctors and hospitals within the EPO's network. However, you cannot go outside the network for covered care. If you do go out-of-network, your EPO will not pay for any services. The only exception is if you have an emergency or urgent care situation.


PPO (Preferred Provider Organization) 3. HMO (Health Maintenance Organization) 4. EPO (Exclusive Provider Organization)

What is PPO EPO?

PPOs (preferred provider organizations) are usually more expensive. In exchange, you will likely get a larger network and the ability to see a provider outside that network. You can also see specialists without a referral. EPOS (exclusive provider organizations) combine features of HMOs and PPOs.

Are EPOs good?

Overall, the combination of its low premiums and low cost-sharing make EPOs a good choice for many people. If you are finding it mind-boggling as you compare different plans, check out our comparison of HMOs, PPOs, EPOs.

Are EPO Plans Bad?

Another major disadvantage of EPO insurance is the inability to see out of network healthcare providers without being responsible for all medical fees. In short, if you are looking for low monthly premiums and are willing to make higher deductibles for healthcare you need, you may want to consider EPO health insurance.

What are some pros and cons of an HMO plan?

HMOs Offer Lower Cost Healthcare

  • PPOs typically have a higher deductible than an HMO.
  • Co-pays and co-insurance are common with PPOs.
  • Out-of-network treatment is typically more expensive than in-network care.
  • The cost of out-of-network treatment might not count towards your deductible.

What is Anthem Blue Cross EPO plan?

EPOs, or Exclusive Provider Organizations, are copay based and only cover services performed solely by providers within their network (with the exception of emergency services). On this plan, you may self-refer to in-network specialists. Medical and mental health coverage is through Anthem Blue Cross.

Why do doctors not like HMOs?

Since HMOs only contract with a certain number of doctors and hospitals in any one particular area, and insurers won't pay for healthcare received at out-of-network providers, the biggest disadvantages of HMOs are fewer choices and potentially, higher costs.

Why are HMOs so cheap?

Many HMO providers are paid on a per-member basis, regardless of the number of times they see a member. This makes HMO plans a more economical choice than PPOs. An HMO generally only covers care received from the plan's contracted providers, known as “in-network” providers.

Why would a person choose a PPO over an HMO?

The biggest advantage that PPO plans offer over HMO plans is flexibility. PPOs offer participants much more choice for choosing when and where they seek health care. The most significant disadvantage for a PPO plan, compared to an HMO, is the price. PPO plans generally come with a higher monthly premium than HMOs.

Does EPO need referral?

You do not need to get referrals to see specialists if they are in the EPO's network. You need referrals to see specialists or to get lab tests. You may be able to get many health services without pre-approval. You will need pre-approval from your health plan before you can get any services.

Does EPO plan require authorization?

Ans: EPO providers have a pre-authorisation requirement for expensive treatments and medications to keep costs low and ensure that their plans cover only necessary things. CT scans, MRI scans, expensive surgeries, prescription drugs and hospitalisations are some things that require pre-authorisation.

Which type of health plan is the most restrictive in terms of who a patient can see and have the plan pay for?

You can choose from traditional health insurance, such as the preferred provider organization, or the HMO, also known as the health maintenance organization. The HMO provides insured individuals with lower out-of-pocket costs, but more restrictive conditions, including the doctor you see.

What does HMO stand for in insurance?

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

What are the four types of medical insurance?

The four types of health insurance plans you should know are:

  • Preferred provider organization (PPO) plan.
  • Health maintenance organization (HMO) plan.
  • Health savings account (HSA)-qualified plan.
  • Indemnity plans.

What are the two main types of health insurance?

There are two main types of health insurance: private and public, or government. There are also a few other, more specific types.

Top Articles
Latest Posts
Article information

Author: Rev. Leonie Wyman

Last Updated: 01/24/2023

Views: 6071

Rating: 4.9 / 5 (59 voted)

Reviews: 82% of readers found this page helpful

Author information

Name: Rev. Leonie Wyman

Birthday: 1993-07-01

Address: Suite 763 6272 Lang Bypass, New Xochitlport, VT 72704-3308

Phone: +22014484519944

Job: Banking Officer

Hobby: Sailing, Gaming, Basketball, Calligraphy, Mycology, Astronomy, Juggling

Introduction: My name is Rev. Leonie Wyman, I am a colorful, tasty, splendid, fair, witty, gorgeous, splendid person who loves writing and wants to share my knowledge and understanding with you.