HMO, PPO, and EPO. What Do They Mean?

health-2082630_960_720You’re most likely looking at these acronyms thinking, “What.”, and wondering what do they all mean? Well, each of these acronyms are different types of health insurance plans that have different features, and it’s up to you to decide which one best suits you!

HMO stands for Health Maintenance Organization, and these types of plans usually have cheaper monthly premiums and lower cost-sharing than other types of plans, but this comes at a disadvantage since you must get primary care provider referrals to see a specialist (Known as PCP referrals) which means you have to get a referral from your regular doctor to see a specialist, and these plans usually won’t pay if you go outside their network of preferred doctors.

PPO stands for Preferred Provider Organization and are called this because they have a network of doctors that they “prefer” you to use— but you can still go to a doctor that is outside their network if you want. Due to this freedom in your choice of doctor, you will face a higher premium than an HMO or EPO in comparison, but some find this preferable to the other plans. A lot of times you would get this type of coverage through an employer, but it is possible to get it as an individual as well!

EPO stands for Exclusive Provider Organization, and these are somewhat of a hybrid of an HMO and a PPO. With an EPO you have to stay within an “exclusive” list of doctors to use, and if you use an out-of-network doctor you won’t be covered at all. But there is an upside to this type of plan, as you do not have to see a primary care physician to go to a specialist (But the specialist has to be in-network!), and you do save money in comparison to a PPO.

family-2073604_960_720When making your decision, just decide what you think is best for you and your family, and which features are most important to you—just take your pick!

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