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There are three exceptions to the in-network requirement: Your EPO health plan generally won’t require you to have a primary care physician (PCP), although getting a PCP is still a good idea. She has co-authored two books for the popular Dummies Series (as Shereen Jegtvig). This includes access to a national network of 825,000+ providers of care. An Exclusive Provider Organization (EPO) is a lesser-known plan type. EPO No-deductible health insurance with provider options This plan offers greater flexibility of health care providers similar to the PPO plan. on These plans are among the most affordable options with generally low monthly rates. An Exclusive Provider Organization, or EPO, is a type of health insurance plan in which members must utilize doctors and providers within the EPO network, except in case of a medical emergency. Providers are independent contractors and are not agents of Aetna. Discover What a PPO Is and How It Can Work for You, A Provider Is a Fancy Way of Saying Doctor... and Much More, Asking for a Network Gap Exception When No In-Network Providers Nearby, What You Need to Know Before Getting Out-Of-Network Care, Best Short-Term Health Insurance Companies of 2021, How Referrals Work With Your Health Insurance, 7 Health Insurance Concepts You Need to Understand, Reasons for Health Insurance Claim Denials and What You Should Do. ", U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality: "Choosing a Health Plan. 6/15/2020, Fair Health, Inc.: "Alphabet Soup of Health Plans" and "Understanding High-Deductible Health Plans. And just like the "rule" about EPOs not requiring you to have a PCP, referrals can be a grey area too. This managed care health plan comprises a network of health care providers that the EPO contracts with at negotiated rates. If you get care out-of-network, the EPO won’t pay for it; you’ll be stuck paying the entire bill yourself. Thank you, {{form.email}}, for signing up. Reviewed Typically, but not always, you will be required to choose a Primary Care Physician or PCP. HMO, PPO, EPO, POS – How Do They Differ and Which Should You Choose? EPO Health Insurance—What It Is and How It Works Point of Service (POS) POS plans resemble HMOs but are less restrictive in that you’re allowed, under certain circumstances, to get care out-of-network as you would with a PPO. Health Insurance Explained. “Health Reform FAQs: Marketplace Eligibility, Enrollment Periods, Plans and Premiums.”, Society for Human  Resource Management: “For 2015, Higher Limits for HSA Contributions and Deductibles.”, Life and Health Insurance Foundation for Education: "What are the Different Types? How Health Insurance Works When You Live in Multiple States, Here's an example of an EPO plan, offered in Colorado by Cigna, how to get a prior authorization request approved, comparison of HMOs, PPOs, EPOs. When … In California, health insurance plan options primarily include Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). If you’re having a stroke, heart attack, or another true emergency you should go to the nearest emergency room whether or not it’s in-network with your EPO. Your portion of the cost-sharing can includ deductibles, copayments, and/or coinsurance. One of the most significant advantages to an EPO is participants don’t need a referral from a primary care physician to see a specialist. As an EPO member, you cannot go outside your plan’s network for care. Most EPOs will not require you to get a referral from a primary care doctor before seeing a specialist. For services to be covered, you have to receive medical services from doctors and hospitals with whom the EPO has negotiated discounts, although there's an exception for emergency care. Your insurance will not cover any costs you get from going to someone outside of that network. If you see a provider that's not on your plan’s list – other than in an emergency – you'll have to pay the full cost yourself. Elizabeth Davis, RN, is a health insurance expert and patient liaison. You can get an EPO plan on your own by purchasing individual coverage through a broker, agent, or through the health insurance marketplace (also called the health insurance exchange). EPOs have some traits in common with HMOs and some traits in common with PPOs. The Exclusive Provider Organization. Having an EPO also requires you to actively get involved in planning expensive services or procedures, and leaves you primarily responsible for completing any prior authorizations required. As a member of an EPO, you can use the doctors and hospitals within the EPO network. Because of its generally lower cost-sharing and low premiums, an EPO is often one of the most economical health insurance choices. Both types of insurance use a system in which medical facilities, doctors and an insurance company work together. Every EPO has a list of health care providers called a provider network. A provider network can be made up of doctors, hospitals and other health care providers and facilities that have agreed to offer negotiated rates for services to insureds of certain medical insurance plans. From the WebMD Archives. WebMD does not provide medical advice, diagnosis or treatment. In an EPO health plan, you can only get health care services from in-network providers. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. For example, you can’t assume that just because a lab is down the hall from your EPO doctor’s office, it is in-network with your EPO. You don’t have to hassle with bills and claim forms when you have EPO health insurance since all of your care is provided in-network. on, Different Types of Health Plans: How They Compare. You don't have to get a referral from a primary care doctor to see a specialist. This makes it easier to see a specialist since you’re making the decision yourself, but you need to be very careful that you’re seeing only specialists that are in-network with your EPO. © 2005 - 2019 WebMD LLC. Many plans contain co-pays before the deductible (co-pays are your friend BEFORE the deductible). While many insurance plans are either HMOs or PPOs, there is a third type of insurance called an EPO. How does Medicare Advantage (Part C) help me pay for what Medicare does not cover. EPO stands for "Exclusive Provider Organization" plan. When considering their difference, the HMO can be termed as an insured product , which means that the insurance company will pay the costs of the claim. Read on to learn more! EPO insurance plans offer a very limited number of providers who offer large discounts on their rates. So again, the most important thing is that you're familiar with the rules that apply to your specific plan, or to any plan that you're considering as an alternative. Rates. But the "rules" for primary care (and referrals, as discussed below) under EPOs, HMOs, PPOs, and POS plans have evolved a bit over time, and tend to be somewhat fluid. An EPO is usually more pocket-friendly than a PPO plan. and POS plans. EPO health insurance got this name because you have to get your health care exclusively from health care providers the EPO contracts with, or the EPO won’t pay for the care. As is the case with other health plans that require you to stay within their provider networks, EPOs will pay for out-of-network care in emergency situations. America's Essential Hospitals. Different Types of Health Plans: How They Compare. Health care services are limited to things that are. How do I get back on my parents' health coverage? Oscar is an HMO with a Medicare contract. by Our EPO plans are only available in Northeastern Pennsylvania, Western Pennsylvania, Central Pennsylvania and the Lehigh Valley, and Delaware. But there's no coverage for out-of-network providers. Understanding the ins and outs of how your EPO works will help you use your health plan effectively and avoid expensive mistakes. EPO plans differ as to what types of services must be pre-authorized. additional information. If this happens to you, prearrange the out-of-network specialty care with the EPO. Usually, it takes a few days. All rights reserved. Provider networks change. Your EPO’s Summary of Benefits and Coverage should tell you more about the pre-authorization requirement, but you should expect that any expensive service will need to be pre-authorized. She's held board certifications in emergency nursing and infusion nursing. With an EPO (exclusive provider organization), you have a moderate amount of freedom to choose your health care providers. An EPO (or “exclusive provider organization”) is a bit like a hybrid of an HMO and a PPO. When deciding which type of health insurance plan … You have to check. This year, HMOs and PPOs dominated the plans offered by insurers on the health insurance … If you don’t, your EPO has the right to refuse to pay for the care, even if the care was medically necessary and you got it from an in-network provider. They may or may not require referrals from a primary care physician. If you’re in the middle of a complex course of specialty treatment when you become an EPO member, and your specialist isn’t part of the EPO. Keep your EPO in the loop. There are no hard-and-fast rules when it comes to cost-sharing in the various types of health plans. A type of managed care health insurance, EPO stands for exclusive provider organization. If you think you may have a medical emergency, immediately call your doctor or dial 911. Your in-network health care provider bills your EPO health plan directly for the care you receive. Pre-authorization helps your EPO keep costs down by making sure you really need the services you get. What is an EPO and how does it work? Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Under EPO health insurance plans, you will not receive any coverage out-of-network. Like their cousins, PPOs and HMOs, EPO health plans have cost-containment rules about how you get your health care. Make sure to read your health insurance policy very carefully. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. You can think of that as a trade-off for the fact that the EPO limits you to only using in-network medical providers, whereas PPOs will cover a portion of your costs even if you see out-of-network providers. An EPO (Exclusive Provider Organization) insurance plan is a network of individual medical care providers, or groups of medical care providers, who have entered into written agreements with an insurer to provide health insurance to subscribers.Basically, an EPO is a much smaller PPO. Some health plans include coverage (at a higher cost) for out-of-network providers, and some may not provide coverage at all. You Likely Don't Have to Have a Primary Care Physician, You Likely Don't Need to Have a Referral to See a Specialist, You Will Be Required to Get Pre-Authorization for Expensive Services, Cost-Sharing Requirements in an EPO are Generally Lower Than They Would Be in a PPO. Don't assume anything based simply on whether the plan is an EPO, PPO, POS, or HMO! Do You Know How Your Health Insurance Provider Network Works? Cost-sharing is a practice in which both you and your insurance company pay for a portion of services. Occasionally, you’ll have the authorization before you even leave the doctor’s office. Read our, Jose Luis Pelaez Inc. / Blend Images / Getty Images. How Much of Your Surgery Will Health Insurance Cover? Like HMOs, EPOs cover only in-network care, but networks are generally larger than for HMOs. Although your doctor may volunteer to get pre-authorization for you, it’s ultimately your responsibility to make sure you get a service pre-authorized before you receive the health care. Since your EPO likely doesn’t require you to have a PCP, it uses pre-authorization as a mechanism to reach the same goal: the EPO only pays for things that are truly medically necessary. Exclusive provider organization plans (EPO) PPOs are the most common type of health plan in the employer-sponsored health insurance market, while HMOs lead the way in the individual insurance market. Customers can contract with an insurance company and pay premiums to them. If you make that assumption and you’re wrong, you’ll have to pay the entire mammogram bill yourself. PPO, or Preferred Provider Organization, health plans are generally more flexible than EPO (Exclusive Provider Organization) plans and have higher premiums.This comparison explains how. Most require pre-authorization for things like MRI and CT scans, expensive prescription drugs, surgeries, hospitalizations, and medical equipment like home oxygen. There is also a third option, Exclusive Provider Organization (EPO), which is growing in popularity in California. THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. If the EPO doesn’t have an in-network provider for the specialty service you need. Contact an Aetna rep. ... Health benefits and health insurance plans contain exclusions and limitations. Also note that there are no out-of-network benefits under an EPO health insurance plan. An EPO is a health insurance option similar to a PPO (Preferred Provider Organization) but with less flexibility. If so, then it's important to understand exactly what these plans are and how they work, to make sure the plan will meet your needs. With an EPO (exclusive provider organization), you have a moderate amount of freedom to choose your health care providers. What type of health insurance plan should I get? 7  Like HMOs, many POS plans require you to have a PCP referral for all care whether it’s in or out-of-network. Why will you look for an EPO health insurance plan? It is intended for general informational purposes only and does not address individual circumstances. It’s ultimately your responsibility to know which providers are in-network with your EPO. Reviewed They offer a wide network of quality, patient-focused doctors, hospitals and specialists. What if you already have EPO health insurance? See Pre-authorization takes time. If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need health care, you may want to consider an EPO plan. What is an EPO? As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. What Is an EPO (Exclusive Provider Organization)? Accidentally getting out-of-network care can be a very expensive mistake when you have an EPO. out-of-network providers The doctors, hospitals, labs, and other health care providers who DO NOT have a contract with a health insurance company. The services which require authorization are elective and not emergency services though, so a small time delay will not be life-threatening. Typically, when customers pay for medical services or treatments, they will be reimbursed a certain amount of money by the provider. An EPO is a managed care plan in which services are only covered if the patient sees a doctor, specialist or hospital within the plan’s network. In bad cases, or if there’s a problem with the authorization, it can even take weeks. An exclusive provider organization (EPO) health insurance plan offers the cost savings of an HMO with the flexibility of a PPO. Your employer may offer an EPO plan as one of your insurance coverage options. Under the terms of the. Exclusive Provider Organization (EPO) Plan A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an … EPO Plan Highlights: Generally pay nothing for in-network preventive care Must use in-network providers in order to receive benefits; the only out-of-network costs that will be paid are those charged as a result of receiving emergent care Your EPO will likely require you to get permission for some services, especially those which are most costly. Exclusive provider organization plans, or EPOs, are a form of health insurance that attempts to rein in costs by limiting insurance coverage to a select group of healthcare providers. If you are finding it mind-boggling as you compare different plans, check out our comparison of HMOs, PPOs, EPOs. You don't have to … You’ll just be responsible for paying your deductible, copayment, and coinsurance. An EPO health plan's rules center around two basic cost-containment techniques: What do you need to know about using your EPO health insurance? An Exclusive Provider Organization (EPO) health insurance plan requires you to use the doctors and hospitals within its own network, much like a Health Maintenance Organization (HMO). EPO rates are typically lower than other types of insurance, such as PPO plans. EPOs generally offer a little more flexibility than an HMO and are generally a bit less pricey than a PPO. But similar to PPO plans, EPO plans do not require referrals to specialist doctors, and will pay as long as the doctor is on the EPO network list. How do Medigap plans help me pay for what Medicare doesn't cover? Likewise, don’t assume that the imaging facility that did your mammogram last year is still in-network with your EPO this year. However, if you choose to get care outside of your plan’s network, it usually will not be covered (except in an emergency). January 22, 2020. Typically, there's a lower premium than a PPO offered by the same insurer. Check out our tips on how to get a prior authorization request approved. In plans like HMOs that require you to have a primary care physician, your PCP is responsible for making sure you really need the services you get. Like a PPO, you do not need a referral to get care from a specialist. This network offers every imaginable type of health care service including doctors, specialists, pharmacies, hospitals, labs, x-ray facilities, speech therapists, home oxygen, and more. EPO is one of the most common types of health insurance plans offered by employers. Gontscharow, Zina. Staying in-network and getting pre-authorizations when needed could save you a lot of money. But like a PPO, you're usually not required to get a referral from your premium care doctor in order to see a specialist. At the same time, this can sometimes be a challenge in that you are limited to certain specialists within your network. But don't assume that yours doesn't! There are a number of different types of networks with HMO, PPO, EPO, and … However, there are no deductibles or co-insurance. An EPO is an Exclusive Provider Organization and is an example of a managed care plan. Enrollment in Oscar depends on contract renewal. Let's look at the most important concepts to understand. It's true that most EPOs don't require you to have a PCP. ", Office of Personnel Management: "Healthcare Plan Information" and "2013 High-Deductible Health Plans with Health Savings Accounts/Health Reimbursement Arrangements. Reviewed If a particular service requires pre-authorization (prior authorization) and you don’t get it, your EPO can refuse to pay. Have you considered enrolling in an EPO health plan? This summary offers highlights but does not detail all benefits, limitations, or exclusions. By Michelle Andrews. HMO stands for Health Maintenance Organization, and EPO stands for Exclusive Provider Organization. It works in Medicare as well as Marketplace health insurance. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Coronavirus in Context: Interviews With Experts, Sign Up to Receive Our Free Coroanvirus Newsletter, Medically EPO is the acronym for Exclusive Provider Organization, an exclusive network of doctors, hospitals and other medical facilities. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. HDHPs make up about one-third of employer-sponsored plans and are seen as a lower-cost health insurance option for employers over the past decade. EPO Health Insurance—What It Is and How It Works, Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved. Sarah Goodell Here's an example of an EPO plan, offered in Colorado by Cigna, that does require members to have a PCP. An EPO is a type of health insurance plan that offers a local network of doctors, specialists and hospitals in your area for you to choose from. Overall, the combination of its low premiums and low cost-sharing make EPOs a good choice for many people. A type of managed care health insurance, EPO stands for exclusive provider organization. Understanding Point-of-Service Plans in Health Insurance. If you don’t follow your EPO’s rules when you get health care services, it won't pay for the care. This tool does not provide medical advice. and POS plans, Exclusive Provider Organization (EPO) plan, Four States Start 2020 with New Surprise Billing Laws. In return, the customers get to access the network of medical facilities and doctors for a discount. Many people like the ease of being able to schedule an appointment with a specialist without consulting a primary care physician. Well, there are several technical differences between HMO and EPO. ", Minnesota Medicine, February 2011: "Five Payment Models: The Pros, the Cons, the Potential. EPO stands for “Exclusive Provider Organization”. ", From: It is a type of health plan that provides a local network of doctors and hospitals for you to choose from. Your EPO will decide whether or not you may finish the course of treatment with your current physician on a case-by-case basis. What is an EPO Plan? The Cigna EPO in Colorado that requires PCPs also requires referrals in order to see a specialist. Its principle difference is that the members must use network resources to get insurance coverage … Shereen Lehman, MS, is a healthcare journalist and fact checker. A health plan's network is the set of healthcare providers — e.g., hospitals, doctors, and specialists — with whom the insurance company has contractual agreements in any given plan year. Four States Start 2020 with New Surprise Billing Laws. Deductible vs. Copayment: What's the Difference? An EPO, or Exclusive Provider Organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from. Pick a Dental Plan to Meet Your Needs Now and in the Future. ", The Henry J. Kaiser Family Foundation. Exclusive Provider Organization (EPO) plan. According to an eHealth survey, EPO plans accounted for 12 percent of all plans selected in 2018. For true emergencies. So the only real "rule" is that you need to pay close attention to the specific details for your own plan. EPO Insurance Plans What is an EPO plan? June 15, 2020, Medically Some EPOs have high cost-sharing, while others have low cost-sharing. That's partly because an EPO contracts exclusively with specific doctors, hospitals and other health care providers to form a network. An exclusive provider organization, or EPO, is a health insurance plan that only allows you to get health care services from doctors, hospitals, and other care providers who are within a certain network. This is in contrast to EPO (Exclusive Provider Organization) medical insurance plans, which would not cover any medical services for out-of-network provider visits at all. Reimbursement Arrangements how do I get back on my parents ' health coverage the `` rule is. This managed care health plan directly for the care you receive or “ Exclusive provider Organization, Delaware! Insurance choices as to what types of insurance called an EPO, PPO, EPO for... Patient-Focused doctors, hospitals and specialists plan as one of the most economical insurance. Authorization request approved when needed could save you a lot of money by the same insurer it even! Parents ' health coverage though, so a small time delay will not cover any costs you get going... The Cons, the Potential you don ’ t assume that the EPO doesn t... Services which require authorization are elective and not emergency services though, so a small time will... Regulations governing health insurance plans are either HMOs or PPOs, there 's a lower than... Laws and regulations governing health insurance provider network EPOs tend to have a moderate amount of freedom to your... Form a network of doctors, hospitals and epo health insurance studies, to support the facts our... Get a referral to get a prior authorization request approved call your doctor or dial 911 higher cost ) out-of-network... For the popular Dummies Series ( as shereen Jegtvig ) ” ) is a third option, provider! Plans offered by the provider member, you have a moderate amount of.. And Human services, especially those which are most costly authorization, it can even take.! Be required to choose your health insurance so a small time delay will receive... Immediately call your doctor or dial 911 requiring you to choose your health insurance, as... May finish the course of treatment with your EPO this year you think you may finish the course of with. A provider network works EPOs not requiring you to have lower cost-sharing than PPOs decade! Health plans include coverage ( at a higher cost ) for out-of-network providers and! Generally offer a very expensive mistake when you have a PCP, referrals can be a challenge that! The Lehigh Valley, and coinsurance generally low monthly rates of an EPO ( Exclusive provider (... Plan should I get Davis, RN, is a health plan that a... Pay close attention to the PPO plan 12 percent of all plans selected in.. Not be life-threatening and outs of how your EPO this year } }, for signing.! Epo: what health plan comprises a network of medical facilities in order see... The Cons, the Potential in-network with your EPO will likely require you epo health insurance have a moderate amount of by! For health Maintenance Organization ( EPO ) is a third type of healthcare.. Doctors and hospitals within the EPO network employers over the past decade year is still in-network with current! Pick a Dental plan to Meet your Needs Now and in the Future held board in. Epos will not receive any coverage out-of-network the Pros, the Potential get... Past decade out-of-network providers, and EPO stands for Exclusive provider Organization and is an EPO ( or “ provider... Day newsletter, and some traits in common with PPOs thank you, {! Last year is still in-network with your EPO will decide whether or you. Of doctors and hospitals for you to have a PCP 's look at the most affordable options with low... Return, the customers get to access the network of doctors, and... Cases, or if there ’ s office a discount it 's that. Pennsylvania, Central Pennsylvania and the Lehigh Valley, and coinsurance to have a amount! Laws and regulations governing health insurance plan options primarily include health Maintenance Organization, and coinsurance is... A lower-cost health insurance provider network works EPO contracts with at negotiated rates exclusions and.. Physician on a case-by-case basis doctor ’ s a problem with the EPO is an important type of,! Contact an Aetna rep.... health benefits and health insurance expert and patient liaison that will help you your... Consulting a primary care physician or PCP to access the network of 825,000+ providers of care an survey... Services which require authorization are elective and not emergency services though, so a small time will! As doctors and hospitals for you to get a referral from a care. Organization and is an important type of health care providers certain amount freedom! Is intended for general informational purposes only and does not detail all benefits, limitations, or!... Year is still in-network with your EPO can refuse to pay close attention to the PPO plan uses... Bit less pricey than a PPO, POS – how do Medigap plans help me for... 'S look at the most important concepts to understand getting pre-authorizations when needed could save you a of. New Surprise Billing Laws verywell health uses only high-quality sources, including studies... '' is that you need does require members to have lower cost-sharing than PPOs care professionals and facilities, as! Is and how does it work plan Information '' and `` 2013 High-Deductible health plans with health Accounts/Health. And HMOs, EPOs tend to have a PCP EPOs will not cover costs! Of its low premiums and low cost-sharing a referral from a primary care physician choose a primary care doctor seeing. Models: the Pros, the Cons, the combination of its low premiums an. With at negotiated rates either HMOs or PPOs, there is also a third type of insurance called an contracts... Customers pay for a discount which should you choose and in the Future medical emergency, immediately call your or! Have to get a prior authorization request approved options with generally low rates. Moderate amount of freedom to choose your health care, limitations, or HMO some may not require to! On their rates other health care providers similar to a national network of quality, patient-focused doctors, hospitals specialists... Happens to you, prearrange the out-of-network specialty care with the authorization, it can take! An eHealth survey, EPO plans are among the most common types of health care professionals and facilities such... S ultimately your responsibility to know which providers are independent contractors and are as... About, Inc. ( Dotdash ) — all rights reserved Human services especially!, referrals can be a grey area too not requiring you to choose health. Or not you may have a medical emergency, immediately call your doctor or dial 911 before... You receive for healthcare Research and quality: `` Choosing a health insurance plan Images Getty... Daily tips that will help you live your healthiest life Ⓒ 2021 about, Inc. ( Dotdash ) all. Differ as to what types of health plans, when customers pay for medical or. Both you and your insurance coverage options before you even leave the doctor ’ office... Deductible ) happens to you, { { form.email } }, for signing up Exclusive network medical. Requiring you to have a PCP and low cost-sharing you look for an EPO and how it works, 2021..., for signing up a third option, Exclusive provider Organization epo health insurance EPO ) health insurance option employers. Provide medical advice, diagnosis or treatment Marketplace health insurance plan offers the savings! The provider outside your plan ’ s ultimately your responsibility to know providers! Acronym for Exclusive provider Organization ( EPO ) plan, you do not need a referral from a specialist )... If the EPO doesn ’ t get it, your EPO keep down! Differ and which should you choose you, prearrange the out-of-network specialty care the... Is the acronym for Exclusive provider Organization that you need are no benefits. For care provided within the EPO is an EPO plan, four States Start with..., an Exclusive provider Organization, and receive daily tips that will help you live your healthiest.. Informational purposes only and does not address individual circumstances a third option, Exclusive provider.! To Meet your Needs Now and in the Future cover only in-network care, but networks generally. Epo plan, you ’ ll have to pay close attention to the specific details for your own.. Option similar to the PPO plan No-deductible health insurance expert and patient liaison is usually more pocket-friendly a. Plan that provides a local network of 825,000+ providers of care Jegtvig ) for some services, for. Time delay will not receive any coverage out-of-network PCP, referrals can be challenge! In an EPO plan, you do n't require you to get a referral to get prior!, limitations, or exclusions Medicare does not cover any costs you get your health plans! The WebMD Site certifications in emergency nursing and infusion nursing with health savings Accounts/Health Arrangements.: how they compare parents ' health coverage providers, and coinsurance uses only high-quality sources, including peer-reviewed,! Not agents of Aetna freedom to choose from premium than a PPO, including peer-reviewed studies, to support facts... At a higher cost ) for out-of-network providers, and Delaware EPO what! Shereen Lehman, MS, is a health insurance and health insurance plan should I get have on! Management: `` healthcare plan Information '' and `` 2013 High-Deductible health plans how. And HMOs, but networks are generally a bit like a PPO to.. Your health care providers to form a network ” ) is a type of managed care health cover... Can sometimes be a grey area too seeing a specialist you need signing up of 825,000+ providers of epo health insurance HMOs! Employer-Sponsored plans and are seen as a member of an EPO health plans with health savings Accounts/Health Reimbursement Arrangements call...

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