Like most business owners, you probably purchase your health insurance policies through an insurance broker. Brokers act on behalf of their clients, unlike agents who work for insurance companies. Using their professional knowledge, an insurance broker will assess your insurance needs and assist you in finding insurance coverage at the best value. One of the most common types of health insurance you will come across is known as EPO insurance. Learn more about what EPO health insurance entails to determine if it meets your unique needs and budget.
What Is EPO Insurance?
EPO stands for “Exclusive Provider Organization.” Similar to a Health Maintenance Organization (HMO), an EPO requires members to use a network of providers that participate in the plan, including hospitals, doctors, and other healthcare providers. As a member of an EPO, you cannot go outside the network of care. The only exception is emergency care. Insurance companies acknowledge that there are certain instances in which you may need immediate care and in these cases you may need to go to the nearest hospital, whether in-network or not. The Affordable Care Act requires insurance companies to treat out of network emergency care the same as in-network care.
Who Should Consider an EPO?
EPOs are essentially a hybrid between HMOs and PPOs as they incorporate features from both. Much like a HMO, most policies require patients to remain within a network of providers. However, members of EPO insurance do not need a referral to see doctors or specialists within their network. Those who wish to have the freedom to see any in network healthcare specialist without seeking a referral from their primary care physician may favor EPOs. As out of network healthcare is not covered, EPOs are best suited for individuals who do not require regular care by specialists outside the network.
Another reason you may choose an EPO is due to the lower health insurance premiums. EPO insurance premiums are generally less expensive than HMOs yet are structured similar to PPOs. While there are several key benefits of EPO insurance, there are also some downfalls that you will want to consider before making your decision. While HMO and PPO plans tend to have a larger choice of caregivers, EPOs are much more limited. Another major disadvantage of EPO insurance is the inability to see out of network healthcare providers without being responsible for all medical fees.
In short, if you are looking for low monthly premiums and are willing to make higher deductibles for healthcare you need, you may want to consider EPO health insurance.
What to Look for in a Policy?
While all EPO policies have the same basic structure, there are some distinct differences between policies and insurance companies. If you tend to travel away from home, you may want to stick with an insurance company that offers nationwide coverage. These larger providers with national networks typically offer members a wide range of healthcare resources. Along with low costs, members can easily access medical care while traveling.
Note that some insurance companies offering national networks may cost slightly more than the same type of plan in a local network. However, this extra cost will likely be worth it if you regularly travel outside your network. You may also want to consider varying member plans, such as networks containing platinum and gold plans. Choosing these more costly plans can provide you with extra benefits, such as dental and vision benefits. However, EPO insurance plans can be a worthwhile investment if you want to bundle more services together.
What Other Plans are Available?
- Preferred Provider Organization (PPO): With a PPO health insurance plan, you are encouraged to use a network of preferred hospitals, doctors, and specialists. These in network providers are contracted to provide medical care at a discounted or negotiated rate. Under a PPO, you are not required to designate a Primary Care Physician. However, you will have the choice to see any doctor or specialist within your plan’s network. You will also be responsible for an annual deductible that you will need to pay before the insurance company covers your medical bills.
- Health Maintenance Organization (HMO): Under an HMO health insurance plan, you will generally have a low out-of-pocket expense which can make the plan favorable among members on a budget. However, HMO members also have less flexibility in their choice of hospitals and physicians. With an HMO, you are required to choose a designated PCP who will take care of most of your healthcare needs. To see a specialist, you will need to get a referral from your PCP.
- Point of Service (POS): POS health insurance plans contain features of both HMO and PPO plans. Similar to an HMO plan, POS plans require you to choose a PCP from a list of in network providers. Any services that are rendered by the PCP are generally not subject to the plan’s deductible. A POS plan may be right for you if you need flexibility when choosing providers and if you desire a PCP to coordinate your care.
- Health Savings Account (HSA): Unlike the other insurances mentioned, a HSA is not actually a health plan. Instead, it is a tax-favored savings account that is typically used in conjunction with a compatible high-deductible health insurance plan. Having a HSA-compatible health insurance plan can help you save money as the monthly premium is typically less expensive than the monthly premium on lower deductible plans.
Contact a Health Insurance Broker
Not sure if EPO insurance is right for you? A professional insurance broker can explain your health insurance options to determine which is best suited for your specific needs and budget. Braving the marketplace on your own can result in choosing the wrong plan. This type of mistake can be costly and time consuming to fix. Make the right decision the first time around with the help of an insurance broker. For more information about EPO insurance or other types of plans, contact your local insurance broker.