With the options you have as someone looking to purchase health insurance, it may be hard to know where to begin. Exclusive Provider Organizations (EPOs) are appropriate for most because it serves as the middle ground in terms of costs and coverage. Whether this plan is right for you will depend on your personal coverage needs and preferences.

Is EPO Coverage Network-Based?

In the case of EPOs, the coverage is based on the plan’s network. A network consists of healthcare providers and facilities under contract with a particular health insurance plan. Certain policies will provide some coverage for non-emergency out-of-network visits, whereas others won’t. EPO coverage is limited to a network. If you go out-of-network, you’ll have to pay all costs unless it’s an emergency.

Do I Need To Choose a Primary Care Physician?

EPO plans do not require choosing a primary care physician (PCP). This is one factor that distinguishes an EPO from Health Maintenance Organization (HMO) and Point-of-Service (POS) plans. Despite having coverage limited to a network, EPOs have more flexibility when it comes to what you can do within the network.

Will I Need Referrals To See Specialists?

With an EPO, you will not have to get a referral before seeing a specialist. However, you will need to get prior authorization, which is where your plan reviews and approves treatment from a certain healthcare provider. You’ll be able to see any specialist as long as he or she is in your plan’s network.

What Are The Costs?

EPOs have premiums and deductibles. The premiums are mid-level, meaning they’re not the cheapest, but they’re not the most expensive, either. EPO plans also have deductibles, which are out-of-pocket expenses you need to cover before the policy’s coverage kicks in. 

How Will I Know If An EPO Is Right For Me?

An EPO is right for you if you are content with staying within a coverage network. Its most appealing quality is what’s possible within the network. An EPO is great for those who want to forgo having to choose a PCP, and want to seek treatments from specialists on their own. It’s also more budget-friendly than a PPO plan. EPO plans are best for those looking for a happy medium.

Get The Best EPO Policy For You

At The Health Insurance Duo, we want you to get the best policy for you. If you need an EPO plan, we’ll provide one that meets your coverage and budget needs, so that you can have a health insurance plan that will keep your medical expenses lower than ever. Call us today at (817) 501-9154.