PPO VS EPO

PPO VS EPO

Did your health plan change this year from PPO to EPO? It happened here in the Central Valley in California, especially if your insurance carrier was Anthem Blue Cross. So, one might ask what is the difference between a PPO plan and EPO plan and while we are at it, how about an HMO Plan? The answer is very simple; a PPO Plan is a Preferred Provider Organization and unlike the name may imply, the name refers to the plan not the insurance company, where it is a Preferred Provider Organizations (PPOs) cover care provided both inside and outside the plan’s provider network. Members typically pay a higher percentage of the cost for out-of-network care, in simple terms, it means, you can see your doctor weather he is in the Company’s network or not, but if he is not, your co-payment will be higher. An EPO Plan stands for Exclusive Provider Organizations (EPOs) are a lot like HMOs: They generally don’t cover care outside the plan’s provider network. Members, however, may not need a referral to see a specialist. HMO Plan stands for Health Maintenance Organization where a member can only see a doctor in the plan network and before you can see a specialist you must obtain a referral from your primary care physician (PCP). In some cases, companies may offer all three plans, EPO, PPO and HMO or HMO and PPO or any combination they choose. It is important to review your plan network and documents as it might affect your co-payments next time you see your doctor.