What Is Epo Insurance?Like most business owners, you probably purchase your health insurance policies through an insurance broker. Brokers act on behalf of their clients, unlike agents who work for insurance companies. Using their professional knowledge, an insurance broker will assess your insurance needs and assist you in finding insurance coverage at the best value. One of the most common types of health insurance you will come across is known as EPO insurance. Learn more about what EPO health insurance entails to determine if it meets your unique needs and budget. What Is EPO Insurance?EPO stands for “Exclusive Provider Organization.” Similar to a Health Maintenance Organization (HMO), an EPO requires members to use a network of providers that participate in the plan, including hospitals, doctors, and other healthcare providers. As a member of an EPO, you cannot go outside the network of care. The only exception is emergency care. Insurance companies acknowledge that there are certain instances in which you may need immediate care and in these cases you may need to go to the nearest hospital, whether in-network or not. The Affordable Care Act requires insurance companies to treat out of network emergency care the same as in-network care. Who Should Consider an EPO?EPOs are essentially a hybrid between HMOs and PPOs as they incorporate features from both. Much like a HMO, most policies require patients to remain within a network of providers. However, members of EPO insurance do not need a referral to see doctors or specialists within their network. Those who wish to have the freedom to see any in network healthcare specialist without seeking a referral from their primary care physician may favor EPOs. As out of network healthcare is not covered, EPOs are best suited for individuals who do not require regular care by specialists outside the network. Another reason you may choose an EPO is due to the lower health insurance premiums. EPO insurance premiums are generally less expensive than HMOs yet are structured similar to PPOs. While there are several key benefits of EPO insurance, there are also some downfalls that you will want to consider before making your decision. While HMO and PPO plans tend to have a larger choice of caregivers, EPOs are much more limited. Another major disadvantage of EPO insurance is the inability to see out of network healthcare providers without being responsible for all medical fees. In short, if you are looking for low monthly premiums and are willing to make higher deductibles for healthcare you need, you may want to consider EPO health insurance. |
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