Exclusive Provider Organization (EPO) Health Insurance Plans

EPO insurance may not be one of the most widely used health insurance plans available, but it could be useful in lowering the amount that you need to pay in insurance premiums every month.

Health care premiums are one of the most common, yet also most frustrating expenses for millions of citizens every year. Although health care is a necessary and worthy expense to make, its prices are rising at an unprecedented rate every year. This has caused many citizens to simply go without insurance at all, therefore risking getting into an accident and needing thousands of dollars for hospital bills.

However, EPO health insurance may be a smart alternative that can allow you to spend less on your health insurance payments every month. While there are many other types of health insurance coverage plans on the market, such as HMOs, PPOs, HDHPs and more, you should make sure that you have done all of the necessary research on the plan that is right for you before making any decisions. This article will teach you more about EPOs, and how you may be able to get one today in order to protect the health of you and your family.

What is an EPO health insurance policy?

Also referred to as an Exclusive Provider Organization, an EPO is a specialized form of health insurance plan that can be purchased in America. It is often considered to be somewhat of a “hybrid” plan between HMOs and PPOs, because of the fact that it has some elements from both of those coverages. In particular, the “exclusive provider” part of an EPO is in reference to the fact that you can only have one network of health care services under such a plan, similarly to HMOs. This means that when you sign up for an EPO, you will only be able to use health care providers that accept your network’s insurance coverage. If you are to visit a health care provider that is out-of-network, you may have to pay for those fees out-of-pocket.

Related Article: PPO Insurance

However, an EPO plan also has elements of a PPO coverage plan within it, as one of the biggest draws of an EPO is that you do not need to get a referral from your primary care physician in order to visit a specialist, such as an eye doctor or physical therapist. This gives EPO consumers a certain freedom and flexibility that they might get in a PPO plan, while still limiting them to health care providers that are within their network like in an HMO plan. These plans are also generally cheaper than traditional PPO plans due to the limited amount of service providers that are available under them, but these costs can vary depending on your specific network.

Who is eligible for EPO insurance?

EPO coverage is generally available for a wide group of people, as it is one of the health care options in the U.S. government’s online health care marketplace. This is a collection of the numerous health insurance providers across the U.S., whose main goal is to compete with each other in selling you the health insurance that you need. However, not all people in the United States are eligible to receive health insurance. You can only legally purchase an EPO if you are:

  • A U.S. citizen, legal resident, refugee, owner of a worker visa or any other eligible immigration status.
  • Currently living in the United States.
  • Not incarcerated.
  • Not receiving Medicare coverage from the U.S. government.

As long as you meet all of these criterion and can afford to pay the various costs associated with health insurance, you are free to purchase whatever kind of policy that you wish.

EPO Plan Costs and Coverages

EPO costs are extremely varied, and do not have designated figures that are easy to prepare for. While the monthly premiums for these insurance policies are usually lower than those of HMOs and PPOs, these prices can vary depending on the type of health care services that you use in a year. EPOs have been effectively utilized by individuals who do not need very much medical attention, and can therefore afford to pay very little on monthly premiums. However, if you get very sick, need to see multiple specialists or have long hospital stays, you may be asked to pay higher-than-average deductibles before your insurance can begin paying the rest. You may also need to pay copays each time you go to your doctor’s office or specialist, and coinsurance after you have already reached your deductible.

Although there are many different EPO insurance coverage options available to a consumer, these can only apply towards health care services that are within their specific insurance network. This can sometimes be seen as a very limiting factor, as your family doctor that you have been seeing for years may not be able to see you once you get an EPO with a different network that the one that the doctor’s office accepts.

However, if you can deal with a more limited selection of doctors, specialists and hospitals, EPOs may be worth it due to their lower-than-average monthly premiums. Additionally, it is also crucial to remember that similarly to an HMO, going to an out-of-network hospital under an EPO is acceptable in cases of emergency. These situations are often out of your own control, and are thus often covered under this insurance plan.

How to Get an EPO Health Plan

Getting an EPO health plan is relatively simple, once you have determined that it is the right type of policy for your health care needs. This kind of hybrid health insurance policy is certainly not for everyone, and you should always be aware of your other options if you would rather have more freedom to choose your doctor, or have the means to pay a bit more for premiums in return for not having a deductible.

However, finding the right EPO provider is as simple as getting quotes from the health care marketplace, finding out the best deal that you can get on your monthly premiums, and eventually making a purchase. This can only take place during the “open enrollment” period at the end of each calendar year, or after a major life event that qualifies you to change your health care status. Once your EPO insurance policy has been approved and purchased, you can then begin paying your monthly premiums, and rest with the peace of mind in having health care if you ever need it.

Related Article: Health Insurance for Families

It might also interest you: