What are the pros and cons of an EPO?
Pros: lower premiums than a PPO and usually no referrals. Cons: no out-of-network coverage except emergencies, so you must stay in network.
EPOs
An Exclusive Provider Organization covers care only inside its network, like an HMO, but usually does not require referrals to see specialists. Out-of-network care is generally not covered except in an emergency, which keeps premiums lower.
How does an EPO handle out-of-network care?
EPOs generally don’t cover out-of-network care except for emergencies, so non-emergency services outside the network are the member’s full responsibility.
What is an EPO plan?
An EPO offers PPO-like freedom inside the network, usually no PCP or referrals, but covers in-network care only, with no out-of-network benefits except emergencies.
Do EPO plans require referrals to see a specialist?
Usually not. Most EPOs let you self-refer to in-network specialists. The catch is that EPOs cover in-network care only, with no out-of-network benefits except emergencies.
What’s the difference between HMO, PPO, EPO, and POS plans?
These describe how a plan manages access to providers. An HMO requires a primary care physician and referrals and generally covers only in-network care; a PPO is the most flexible (no referrals, some out-of-network coverage); an EPO covers only in-network care but skips referrals; and a POS plan blends HMO and PPO features.