Health insurance is an important aspect of managing your health as it involves being a part of a company that can help you settle your medical bills. The idea behind insurance is to help you cover your medical costs in the event of an illness or injury. Choosing the health insurance plan that best suits you is difficult, as you will face three different plans.
Your decision will be based on your lifestyle, employment, income, and overall medical and financial needs. This article will explain the difference between the three plans (HMO, PPO, and EPO). Please keep reading to make an informed decision.
Difference Between HMO, EPO, and PPO Health Insurance Plans
HMO
This stands for health maintenance organization; it is a type of health plan offering members a local network of hospitals and doctors.
The members get to choose from the network of doctors and hospitals provided. Their services come at a lower monthly premium than other plans.
This plan makes choosing a PCP mandatory, meaning you can choose your health provider from a large group of affiliated physicians in the same geographic area.
Your PCP helps you coordinate your health care by offering you referrals in case you need to see a specialist or any other doctor in the network.
With HMO, you pay a lower monthly insurance premium and a higher deductible and receive quality care at all times.
In the HMO plan, if you go out to an out-of-network hospital or doctor, you must pay out of your pocket for all non-emergency healthcare rates.
PPO
This stands for preferred provider organization; it is a type of health plan offering a very large network of hospitals and doctors.
With PPO, be prepared to pay a higher monthly premium due to its higher out-of-pocket costs and deductibles.
PPO is expensive because you have the flexibility to choose your physician and health care options.
With PPO, you can see any specialist of your choice without a referral, and using out-of-network doctors will be paid by the plan.
EPO
The EPO stands for exclusive provider organization; it is a type of health plan that offers a local network of hospitals and doctors for members to choose from for their health care.
EPO is quite pocket-friendly, if you choose to use hospitals and doctors outside the plan’s network you will most likely pay out of your pocket.
With EPO, you will get a lower monthly premium and a little higher deductible, and here, you have to make your appointments with specialists.
Difference Between HMO, PPO, and EPO
The three plans are not the same, they vary in several ways such as:
Cost: the premiums you pay are not the same
Out-of-pocket: the out of pocket you may vary according to the plan
Referrals: some plans require referrals in case of seeing a specialist, others don’t
Flexibility: some are more flexible than others in terms of using out-of-network doctors
PCP: not all plan requires you to have a PCP
FAQs
What are the Benefits of HMO?
There are several benefits of HMO, below are some of them:
- Lower out-of-pocket costs
- Access to quality healthcare services
- Access to specialists without referrals
- Reliable coverage if you change jobs or location
What are the Benefits of PPO?
There are several benefits of PPO, below are some of them:
- Increased access to pre-planned discount rates
- Greater access to healthcare services without out-of-pocket costs
- Improved customer satisfaction
- They have pre-arranged rates in place
What are the Benefits of EPO?
There are several benefits of EPO, below are some of them:
- Less expensive
- Access to a specific list of doctors
- Access to a specific list of hospitals
Check Out:
- HMO – Health Maintenance Organization
- HMO and PPO Health Insurance Plans
- PPO – Preferred Provider Organization
- EPO – Exclusive Provider Organization
