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EPO Health Insurance

What is an EPO plan?

An Exclusive Provider Organization (EPO) plan is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).

How does EPO work?

Similarly to HMO plans, EPO plans cover services rendered by providers that are in-network (for a certain geographic area) ONLY. Out-of-network care is not covered except during an emergency. Unlike HMO plans, you are not required to have a Primary Care Physician (PCP), nor are you required to have a referral in order to visit a specialist. However, any specialist you visit MUST be in-network.

Are EPO plans expensive?

With an EPO plan, you can expect to pay a lower monthly premium than you would for a PPO plan. Additionally, because you are required to stay in network for services your deductible and other out-of-pocket expenses can be kept low. Similarly to some HMO plans, you may not owe anything for care received during a hospital stay once you’ve met your deductible.

Am I eligible for an EPO plan?

The Open Enrollment Period for 2018 coverage is now open and runs from November 1st - December 15th. This means it's your time to sign up for an affordable Health Care plan. Don't miss your chance to enroll!

Why should I choose an EPO plan?

EPO plans offer cost-effective healthcare AND the flexibility that you don’t get with HMO plans.

A lower monthly premium doesn’t mean a higher deductible.

You don’t have to visit a PCP before you can see a specialist, and YOU get to choose your specialist, provided they’re in-network.

Your service provider works with the insurance company directly, so you don’t have to file any claims.

Why should I NOT choose an EPO plan?

Before choosing an EPO plan, there are several important things to consider:

Coverage will only be provided for services received by in-network providers. So, you may owe much more (if not full cost) for out-of-network services, unless it’s a medical emergency.

EPO providers are split by geographic area. You may not have access to healthcare that best suit your needs if your area doesn’t have many in-network providers.

Although a referral is NOT required from a PCP in order to see a specialist, the specialist must also be in-network. This can limit your options when it comes to who provides your care.

What are the alternatives to an EPO plan?

There are several other healthcare plans available to meet your needs. Check out the links below for more information.

HMO

Health Maintenance Organization (HMO)

Great choice for people who want to keep their premiums low, especially if you’re happy to see your PCP first when you need more specialized care.

Learn more »

PPO

Preferred Provider Organization (PPO)

Perfect for people who prioritize choice and flexibility. Premiums are higher than other plan types but you’ll have coverage for more care providers.

Learn more »

POS

Point of Service (POS)

POS plans are similar to HMO plans but offer the increased flexibility of providing coverage for care costs outside of the network.

Learn more »

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