HMOs vs EPOs

Comparing and Contrasting a Health Insurance HMO and EPO Plan


HMOs and EPOs are just two of the types of insurance plans that companies will offer. Today, we will look at their similarities and differences. 



An HMO is a Health Maintenance Organization plan that will require the selection of a primary care physician. This primary care physician will be required to coordinate your care by recommending you to specialists if need be. After you find the best specialist, you can talk with your primary care physician to receive the recommendation. This specialist must be in-network or else you will pay all of the costs out of pocket. In the case of an emergency, the HMO plan will cover all incurred costs. Your network of providers are generally local, so you will not have to travel out of state to see a doctor. 



An EPO is an Exclusive Provider Organization. This type of plan offers more network flexibility than an HMO. Additionally, EPOs tend to be less expensive than a PPO. With an EPO a referral to a specialist from your primary care provider is not needed. An EPO will also have a network of providers that will be covered by your insurance, however it will only cover costs incurred on visits to in-network providers.

Both an HMO and EPO will cover out of network charges for medical emergencies. One difference is that the PCP referral is required on the HMO but not on the EPO. Additionally, the Primary Care Physician is always required on the HMO but not always on the EPO. An EPO is best for people who are looking for lower monthly premiums and may be willing to pay a higher deductible when receiving care. An HMO may be best for those who want their care to be coordinated by someone else and prefer a higher deductible with a lower monthly premium. To find the best plan for you, use SmartSelect from Nayya!