Alphabet Soup: HMO vs. PPO vs. EPO. Which one is right for you?
You seen these acronyms describing doctor groups before, but what do they mean and why should you care?
It all comes down to network "design" and flexibility
Each insurance company "contracts" with hospitals, doctors, nurses and other medical providers who agree to charge a discounted price for their services. This group of providers is called a "network." Some types of plans will cover you if you go to providers outside your network; others won't. Some plans also require that your primary doctor provide a "referral" before they will pay for a specialist doctor visit.
Here's the gist:
HMOs only cover you if you stay in-network and require referrals to see specialists.
PPOs often have higher plan premiums but offer partial coverage if you go out-of-network and don't require referrals to see specialist.
EPOs also only cover you if you stay in network, but you can see specialists without referrals. Think of them as in-between an HMO and a PPO.
And here's the nitty gritty: