When it comes to health insurance plans, there are several options available, including EPO, HMO, and PPO plans. Knowing the differences can help you make an informed decision so that you’ll get the right coverage that fits your budget. The network size, deductible, and premium costs of plans you have access to may vary, so the info below is generalized and will not be accurate 100% of the time.
What are HMOs, PPOs, and EPOs?
- An HMO, or Health Maintenance Organization, is a type of plan that typically has lower monthly premiums, but higher deductibles, than PPO or EPO plans. With an HMO, you must choose a primary care provider (PCP) who coordinates your care and refers you to specialists within the network for specialty care. (Some HMO plans do not require referrals.) There is no out-of-network coverage unless it is a medical emergency. Typically, HMOs will have lower costs than PPOs and EPOs. Some HMO plans offer low deductibles with higher premiums, and some offer low premiums with high deductibles. Select an HMO plan if you want a lower cost option and don’t need to visit anyone outside the network.
- A PPO, or Preferred Provider Organization, offers a larger network of doctors and hospitals to choose from and generally has higher monthly premiums than an HMO. There is some coverage for out-of-network expenses at a higher cost to you than if the provider was in-network. Select a PPO plan if you’re willing to pay a higher premium to get the largest network of providers and coverage for out-of-network services. This is your best option if you’re likely to need numerous medical treatments.
- EPOs, or Exclusive Provider Organizations, combine features of HMOs and PPOs. They have exclusive networks like HMOs, but the networks are larger. There is no out-of-network coverage unless it is a medical emergency. Be aware that EPOs are not currently as common as other plan types, and many carriers don’t offer them. Select an EPO plan if you want a wider network of doctors to choose from than an HMO, lower costs than a PPO, and don’t need to visit anyone outside the network.
How to Get Health Insurance Coverage
A and H Insurance works with many individuals to find them and their families the right health coverage. We can also work with your business to find a selection of group health & life benefits plans to offer to your employees. Give us a call today at (775) 829-2600 and ask to speak with a member of our health & life benefits team, so we can get to know your company’s needs and budget.
