What is the difference between epo and ppo insurance

There may be a lack of viable EPO providers near you, depending on where you live. In this case, your decision would be much easier. But, if you can handle an increased rigidity in your healthcare providers, an EPO may ultimately prove more valuable for you or your family. Well, as with most decisions in life, it depends.

And to learn more about these plans and all other health plan types, contact The Olson Group, today! Do I need a primary care physician? Often , but not always. An EPO generally requires you to have a primary care doctor but varies from plan to plan. You can select any doctor you choose, but you will pay more for out-of-network care. PPO stands for preferred provider organization. Unlike the EPO, where members are strictly held to a more narrow selection of health care facilities, physicians, and pharmacies, the PPO allows some coverage for out-of-network providers.

Of course, the PPO members will pay a higher premium for this option. Both an EPO and PPO may not require referrals for in-network and out-of-network services, which can offer significant time savings.

With a PPO, members have access to out-of-network providers. A downside to this is that these expenses could be high and cost more than any reimbursement from the insurance carrier. Some people find that paying more prevents them from seeking medical treatment in the event of an illness or accident. An advantage of PPO is flexibility and convenience. If there are several in-network providers, members can switch to an out-of-network provider and still have some coverage for the fees. Of course, if you have a large family or need help with special medical needs or chronic health conditions.

For example, for those that require frequent care, such as dialysis, you might want to opt for a PPO for the wider selection of providers. When you have more options, you might be able to cut the wait time from two months to one. On the other hand, an EPO is a type of managed care health insurance coverage that saves money because it offers fewer options for members.

However, limited access to providers can be costly if members are sick or injured and need immediate medical attention outside the network. There are two tiers, in-network and out-of-network. An EPO is restrictive. The main difference between PPOs and EPOs is in regard to flexibility, which is indicated by the names of the two plans.

In a PPO, the insurer has a network of healthcare providers that it prefers to work with. However, if you need or want to go to a healthcare provider from outside this network, the PPO will still help to pay for your treatment. However, you will be expected to provide a larger contribution than if you were treated within the network. In an EPO, the insurer has a network of healthcare providers that it works with exclusively.

Apart from in exceptional circumstances, such as emergency care, an EPO will not pay anything toward treatment undertaken with healthcare providers from outside its network. PPOs are usually more expensive because they are more flexible in allowing you to seek treatment outside of their network of preferred providers.

The cost of a PPO plan will also increase the more often you take advantage of that freedom, as you are expected to cover a higher proportion of the costs incurred in seeing healthcare providers from outside the network. EPOs are usually cheaper due to the restrictions on which healthcare providers you can visit.

Keep in mind that if you visit a healthcare provider from outside your EPO's network, you will almost certainly have to pay the full cost of any treatment. In both cases, expect to have to contribute at least a small sum towards any medical treatment, including visits to your doctor.

Both EPO and PPO plans usually require you to make a small payment to receive treatment from a provider within the network. This payment is known as a "copayment" when it is a fixed cost and "coinsurance" when it is a percentage of the total cost; it is a payment on top of any monthly premium costs.

See also Coinsurance vs Copay. In an EPO plan, you must also pay the full expense of any treatment received from a healthcare provider outside the network. In a PPO plan, treatment received from outside the network is partially covered by the insurer, but you can expect to pay more than if you stay within the network. These additional fees are said to be included in the plans to ensure people do not take advantage of the system by visiting their healthcare providers more often than necessary.

However, you are free to develop a relationship with a doctor of your choosing, although additional costs will apply if the doctor you choose to see is outside of your network. In other words, you must contact your insurance company before undergoing any major treatment to ask them to authorize the work.

If you do not do this, the insurance company will not be liable to pay, even if the treatment can be shown to be medically necessary.