HMOs, PPOs, and EPOs: Know The Differences | HealthTN

HMOs, PPOs, and EPOs: Know The Differences

Anastasia Iliou Affordable Care Act/Obamacare, Medicare, Uncategorized

Choosing a health care plan can seem like an extremely daunting task. You need to choose an agent, a carrier, and a plan; how much you’re willing to spend, and how much coverage you need. Your agent may ask you about HMOs, PPOs, and EPOs. Do you know the differences?

HMOs (Health Maintenance Organizations) 

HMOs are good options for those who have one primary physician that they see and don’t plan on changing. With an HMO, you are only covered with one appointed doctor (except in the case of an emergency) which generally makes them cheaper.

In HMO scenarios, you’ll need to go to your primary physician first for ANY medical concern. Your physician can then refer you to another doctor where you can have your services covered. However, most of your care will need to happen with your primary physician. The only exception to that is for women who need to see an OB/GYN.

The added benefit to an HMO is that all of your health care will be centralized with one doctor’s office. That means no extra paperwork, no searching for specialists on your own, and no worries over whether or not your care will be covered (as long as you go directly to your primary physician).

EPOs (Exclusive Provider Organizations)

EPOs fall in-between HMOs and PPOs on the flexibility scale. An EPO does not require that you choose one primary physician, but it does limit what doctors and specialists are available in your network. Any doctors outside of your network will not be covered except in the case of an absolute emergency.

Due to the network restrictions, an EPO will give you lower overall costs.

PPOs (Preferred Provider Organizations)

PPOs are essentially the opposite of HMOs because you are not required to see any one doctor. With this option, you don’t necessarily have to go to doctors who are within your network, but you’ll receive more coverage if you do. A PPO gives you the freedom to visit whatever doctor or specialist you choose.

POS, or point-of-service plans, are like hybrids of PPOs and HMOs. You have the freedom of a PPO, but you have to start by choosing one primary physician.

If you have questions about HMOs, EMOs, and PPOs or would like to discuss your plan options with an agent, call HealthTN today at 615-541-4257.

Anastasia graduated from Belmont University with a Bachelor's degree in Songwriting. When she's not writing, she's on a mission to visit all 50 states in the U.S (and to date has reached 41). Anastasia loves writing music, hiking, and playing with her pets (hedgehog, cat, and dog). She loves animals (but not so much bugs) and spends her free time volunteering for The Elephant Sanctuary in Tennesee.