What is an exclusive provider organization (EPO)?

An exclusive health insurance provider's association or EPO enables only physicians, hospitals and other healthcare providers within a specific networks to provide you with healthcare services. There are no costs the policies covered for moving to anyone outside the network. The only difference is that emergency treatment generally is covered.

You have to find a primary care practitioner from several EPO insurance policies (PCP). A PCP is a doctor who can treat mild and chronic diseases as well as preventively. (If PCPs are for infants, people can also be referred to as a general practitioner, family physician or pediatrician.)

Another distinguishing characteristic of the EPO policies is that the primary health care provider does not have to refer you to a specialist doctor. If you want an insurance provider to pay a visit to a doctor, you must also obtain a referral from your PCP for all health insurance policies requiring a PCP.

While an EPO limits your healthcare choices to local network providers, it typically means that you receive less monthly benefits since your network suppliers have contracts with your insurance company. On the other hand, an EPO health care plan also demands that you spend more before your medical costs appear to be covered.

How an EPO plan works

An EPO is a managed care scheme, and that means, as long as you visit a medical provider – doctor, hospital, or other healthcare service site – in a given network, the health insurance scheme can cover some of your medical expenses. You will have to pay some of the costs alone, through copayments, but the insurance provider will cover some of the costs until you get a deductible.

EPO plans and out-of-network providers

Controlled health insurance schemes exist that vary largely from one another whether you can go to out-of-network providers and how much the insurance company will pay if you leave the network.

The costs you incur from an EPO insurance contract to outside-network providers will not be covered. This isn't perhaps a big deal if you are just having treatment close to home, but remember that if you fly and want to see a physician outside of the network you would have to pay for it.

The great exception is that emergency treatment is covered. The affordable care law, also called the ACA or Obamacare, would not allow health insurance firms to charge higher copayments or off-network insurance. Thus, if an ambulance is required or an emergency hospital is admitted, an EPO shall cover the costs.

However, once an emergency exists, the policies will not cover the expenses. Your off-line expenditures could also not be included in respect of your regular deduction.You probably need the permission from your provider to make an out-of-network hospital stay in a non-emergency situation.Your insurance would probably not cover your hospital bill without prior approval. See the specifics of a single strategy and find out more about it.

Seeing a specialist with an EPO

Another point of sale for EPO plans is that a professional is not to be referred. Other premiums for a primary care doctor normally do not cover the expense of seeing a specialist if your PCP does not mention this specialist directly. You may also get higher copays or assurances when you see a specialist.

The cost of EPO plans

You would have to pay a monthly fee, much as for other forms of health insurance, to obtain insurance coverage from an EPO. The cost of your premium depends on your location and your particular plan, but EPO policies typically have mid-term premiums.

When you look at insurance rates, one question is what kind of package you have. In certain cases less expensive insurance is an HMO scheme, which is more stringent. More costly plans are also more accessible for non-professional providers to visit. The following section outlines the traditional alternatives to the EPO plans.

How to get an EPO plan

You can only select the EPO plan if your company provides an insurance package through your employer.

You can get an EPO on the market if you do not receive insurance coverage through work. The Accessible Care Act has provided a demand for people to purchase health insurance policies. You will find EPO plans to compare costs and plan benefits to choose the right option for you. The EPO plan can be compared. In order to pay the maximum amount you can ever pay before the policy starts covering 100 percent of your expenses, you should be sure to calculate the expense of copays (both inside and outside of the network), insurance, deductibles and the extra pocket maximum.

If you get a scheme through work or on the market, only during open registration, from November until December, will you be able to choose the new scheme when anyone is entitled to an insurance policy. You can apply for special registration while changing jobs and undergoing important life changes, including the birth of a child, so that you can enroll beyond the open registration period in a new programme.

3 alternative health insurance plans

A variety of medical insurance options are available and all of them have very different costs and benefits. Three different forms of medical insurance policies you can consider in place of an EPO are presented here.

EPO vs HMO

A health support organization (HMO) is similar to an EPO since it requires you to select a primary care physician and only if you go to an in-network provider can the employer pay health insurance expenses. However, if you want to see a physician, HMO plans demand that you have your primary doctor referral. Your insurance would not cover the risk if you go to a doctor without a referral. (See an OB/GYN as the only exception.)

The most competitive rates are typically in the HMO health insurance policies.

EPO vs PPO

If you are not fond of an EPO, consider the preferred provider organization (PPO) to be limited to in-network doctor. PPO's insurance cover at least some of the costs associated with treating external hospitals, while in-network physicians are cheaper.

PPO policies don't pay as much for an out-of-network Physician, but the whole bill would at least not be paid out of your pocket. PPO can also increase the premiums than an EPO, but this is dependent on the insurance provider and the venue.

EPO vs POS

A service point (POS) acts as a combination of the above-mentioned HMO and PPO plans. POS plans can require you to choose a primary care physician, and without reference you cannot see a specialist physician just as an HMO. POS plans, however, provide greater opportunity for non-networked physicians and suppliers, such as a PPO.

Usually, POS schemes have lower cost premiums compared to HMO schemes but lower than PPO schemes.