Insurance Overview: Difference Between HMO, PPO, and EPO

Insurance Overview: Difference Between HMO, PPO, and EPO

Posted by Dr. Pittman on Jun 9 2021, 10:32 PM

When opting for health insurance, identifying the differences between various plans and choosing the suitable one can be challenging. The common types of plans offered by most insurance brands are:

  • Health maintenance organizations 
  • Preferred provider organizations
  • Exclusive provider organizations

Read on to know the differences between these plans and how to pick the best one for you.  

Health Maintenance Organization (HMO)

HMO provides health care services through a network of doctors and hospitals. 

  • With HMO, you need to choose from a local network of healthcare providers. You may need to pay the bill if you consult a doctor outside the network.
  • Patients having an HMO plan should see their primary care physician (PCP) first. He will refer you to an in-network specialist if needed.
  • With HMO, there are no claim forms to fill out.
  • The monthly premium of HMO is lower compared to other plans.
  • With HMO, you may need to pay the deductible - the amount towards medical treatment before the insurance company covers the costs. 

An HMO may be suitable for you if you're happy visiting a primary care provider (PCP) for your healthcare needs and are ready to spend a higher deductible to gain a lower monthly insurance premium.

Preferred Provider Organization (PPO)

Preferred Provider Organization offers a more extensive network of doctors and hospitals. 

  • With PPO, you get more freedom to choose your doctors and health care facilities. And, you don't need a referral from a primary care physician to consult a specialist.
  • Your out-of-pocket costs will be higher with a PPO if you see out-of-network healthcare providers. 
  • If you see doctors who are in the network, there is little to no paperwork. However, the plan involves more paperwork if you visit doctors outside the network. 
  • The monthly premium with a PPO is higher than HMO. 
  •  Some PPOs may have a deductible and have to pay more when you see a doctor outside the network.

PPO may be the right fit for you if you are ready to pay a higher monthly premium to have more options to select your doctors.

Exclusive Provider Organization (EPO)

Exclusive Provider Organization offers a local network of healthcare providers and facilities for the patients. 

  • With EPO, you will have moderate freedom to select health care providers. You can consult a specialist without a referral from a primary care doctor. 
  • If you see doctors outside of your plan's network, except in case of emergency, it will not be covered. 
  • With EPO, the paperwork is very little. 
  • An EPO's premium is lower than a PPO. 
  • Some EPOs may have a deductible. 

EPO may be the best choice for you if you want to pay lower monthly premiums but are ready to pay a higher deductible when health care is needed. 

The bottom line

Being familiar with the benefits offered by these plans can help decide the one that fits your budget and requirements. Dental SPA, Sanford, accepts most of the insurance plans. 

Contact us at (407) 330-3601 to verify the acceptance of your plan. 




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