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What Is an EPO Insurance Plan?

what is an epo insurance plan

EPO insurance plans require you to stay within your network.

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Choosing a health insurance plan to meet your personal and your family's needs can entail dealing with a lot of options. The basic names of insurance plans are often referred to as their acronyms, which can be confusing if you don't know what all of them mean. Exclusive provider organizations, or EPOs, are one of the commonly available insurance plans to individuals and members of group insurance plans.


EPO insurance plans work within specific networks. As a member of an EPO plan, you can visit any provider within your network; you will be covered under the terms of your specific plan, though you might be responsible for co-payments or deductibles. You do not need to elect a primary care physician (PCP) to refer you to see a specialist. In an EPO plan, you have the right to see a specialist at any time without any referral.

EPO Plans Compared To Others

EPO plans are similar to health maintenance organizations (HMOs) because they both provide coverage only on an in-network basis. However, an HMO plan requires members to chose a PCP, who must provide a referral if you need to see a specialist. EPO plan members have PCPs, but a referral isn't required for specialist visits. Typically, HMO plans cost more than EPO plans because HMO rates are based on a per-person monthly rate whereas EPO rates are calculated based on individual services. A preferred provider organization (PPO) generally is the most expensive type of health insurance because they have networks but also provide coverage for out-of-network care. The out-of-network costs usually are not paid in full by the insurance provider; instead, the provider covers a certain percentage of the total bill and you are responsible for the remaining balance. EPO prescription drug plans don't differ a lot from the other types of health care.

Out of Network and Emergencies

Category: Insurance

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