{"id":11842,"date":"2020-06-01T13:00:04","date_gmt":"2020-06-01T17:00:04","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=11842"},"modified":"2020-07-02T13:34:26","modified_gmt":"2020-07-02T17:34:26","slug":"hmo-vs-epo-vs-ppo","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/hmo-vs-epo-vs-ppo\/","title":{"rendered":"HMO vs. EPO vs. PPO: What are the differences?"},"content":{"rendered":"

The idea behind health insurance is simple: It helps cover your medical costs if you have an injury or illness. But the reality of health insurance in America is a bit more complicated. There are a lot of acronyms involved\u2014HMO vs. EPO vs. PPO vs. POS vs. HSA vs. PCP. Figuring out which insurance plan is best for you can be confusing.<\/span><\/p>\n

Three common types of health insurance plans are HMO, EPO, and PPO plans. Your decision will be based on your income, lifestyle, and employment, as well as your family’s overall health, finances, and medical needs.\u00a0<\/span><\/p>\n

“The most important thing\u00a0is to evaluate all the factors before choosing\u00a0a plan, rather than thinking that this group of letters is better than another group of letters,” says Vincent Plymell, assistant commissioner of the Colorado Division of Insurance. “In terms of choosing between HMOs, EPOs, and PPOs, in recent years these types of plans have become more and more similar, so it becomes less about the name of the plan and more about the services within that plan.”<\/span><\/p>\n

HMO vs. EPO vs. PPO<\/h2>\n

A health maintenance organization, or <\/b>HMO<\/b><\/a>, <\/b>is a type of healthcare plan that gives you access to a network of providers, hospitals, and healthcare providers in your area. Typically, HMO plans require you to choose a primary care physician (PCP). This is “your doctor,” the one you consult with first about any health issues. If you need additional healthcare services, your PCP will refer you to a specialist within the HMO’s network. If you go to an out-of-network doctor or hospital, you’ll most likely have to pay out of pocket for non-emergency healthcare costs.<\/span><\/p>\n

An exclusive provider organization, or EPO,<\/b> is like an HMO in that they both consist of a network of healthcare providers and facilities. Although you must choose a primary care physician with most EPOs, you don’t need a referral to have access to a specialist\u2014unlike an HMO. An EPO\u2019s network can also be more extensive than an HMO network. Unless it’s an emergency situation, HMOs and EPOs generally require you to pay all costs for any out-of-network care.<\/span><\/p>\n

With a preferred provider organization, or <\/b>PPO<\/b><\/a>, <\/b>your health insurance plan has a network of healthcare providers and facilities in your area and around the country that it works with and would “prefer” you seek out. If you go to these providers, a larger portion of your costs will be paid for by the plan. Unlike EPOs and HMOs, PPOs will cover some out-of-network costs as long as they are for covered services. A PPO\u2019s network often includes providers in different states, and, as with an EPO, you won’t need a referral from a primary care physician to see a specialist.\u00a0<\/span><\/p>\n

HMOs offer the least flexibility but usually have the lowest monthly costs. EPOs are a bit more flexible but usually cost more than HMOs. PPOs, which offer the most flexibility, are typically the most expensive.<\/span><\/p>\n

Which is best: PPO, EPO, or HMO?<\/h2>\n

Everyone’s healthcare needs are different. Some people require routine medical services. Others have prescriptions that need to be filled. And lots of people are healthy as can be and have almost no healthcare needs at all. That’s why it’s impossible to say which type of plan is the best. The answer varies from person to person, state to state, and employer to employer.<\/span><\/p>\n

During <\/span>open enrollment<\/span><\/a>, you will need to ask yourself some questions before you choose a policy:<\/span><\/p>\n