Every health insurance policy has its own way of operating when it comes to networks, selecting primary care physicians (PCPs), coverage for seeing specialists, and policy costs. The same idea applies to Exclusive Provider Organization (EPO) plans. When compared to others, EPOs are the middle ground in terms of flexibility and costs.
How Does Network Coverage Work With EPOs?
A network consists of select healthcare providers and medical facilities under contract with a health insurance plan. EPO plans require you to strictly adhere to the plan’s network. If you get medical services out-of-network, you will have to pay all expenses out-of-pocket, unless it is an emergency.
Does An EPO Require Me To Choose A PCP?
EPOs do not require choosing a PCP. Instead, you will be able to seek treatment from any clinician within your plan’s network, including specialists. Instead of having to get a referral from a PCP, you will only need to have your EPO plan approve your visit to a specialist (this is known as prior authorization).
How Does EPO Coverage Impact Costs?
EPO costs include premiums and deductibles. Premiums are monthly payments required to maintain the policy, and deductibles are the out-of-pocket costs that you need to cover before your policy’s coverage becomes effective.
Since EPO plans give you the freedom to seek specialist treatments without the need for a referral from a PCP, but strictly offer in-network coverage, the costs are in the middle. They’re not the cheapest, but they are not the most expensive, either. EPOs are the middle ground between two extremes – HMO plans, which have the most restrictions, and Preferred Provider Organization (PPO) plans, which are the most flexible.
What Are The Key Takeaways Of EPO Plans?
In short, EPO plans:
- Only cover in-network treatments
- Strictly cover emergencies if treatment takes place out-of-network
- Do not require choosing a PCP
- Cover in-network specialist visits as long as there has been prior authorization
- Have premiums that are more expensive than HMOs, but cheaper than PPOs
- Require paying a deductible before coverage kicks in
Get Your EPO Plan Today
If you’re interested in getting an EPO plan, The Health Insurance Duo is the ultimate provider. You’ll get access to the best EPO plans on the market, meaning you’ll get the best coverage at the lowest rate possible. We’re here for you, and we are ready to get you the policy you deserve. Call us today at (817) 501-9154.
