There are many different types of health insurance coverage out there, but they mainly fall into one of two camps: Health Maintenance Organization (HMO) plans and Exclusive Provider Organization (EPO) plans. There are pros and cons to each, and which one is right for you ultimately comes down to preference. Here’s an HMO EPO plan comparison to determine which option is right for you.
What Is a Health Maintenance Organization (HMO) Plan?
A Health Maintenance Organization plan (or HMO plan) is a type of insurance plan for which you’re required to choose a primary care physician (PCP) who is then in charge of managing your care — or “maintaining your health.” If you need to see a specialist, like a cardiologist or dermatologist, you have to get a referral from your PCP first.
HMO plans have much stricter networks compared to EPO plans. You can’t just go to any specialist; you have to get a referral from your primary care physician. But because of the limited networks and mandatory specialist referrals, HMO plans typically have lower premiums compared to EPO plans.
What Is an Exclusive Provider Organization (EPO) Plan?
Exclusive Provider Organization plans (or EPO plan) are more flexible than HMO plans. They still have a network of providers you have to use (except in an emergency), but there’s no requirement to choose a primary care physician or get a referral before seeing a specialist. You’re free to visit any doctor, hospital, or specialist in the network whenever you need. The lack of needing referrals is the main HMO EPO plan comparison difference.
EPO plans also typically have larger networks compared to HMO plans with a broader selection of providers, which is appealing to many who like to have more control over their care. Of course, the larger network and lack of referral requirements mean that EPO plans are typically more expensive compared to HMO plans.
HMO EPO Plan Comparison: Which Is Right for You?
When it comes to an HMO EPO plan comparison, the main difference comes down to referrals. HMO plans require referrals from your primary care physician to see a specialist, while EPO plans allow you to visit any doctor, hospital, or specialist within the network. But because of the flexibility and larger network, EPO plans typically have higher premiums compared to HMO plans.
So, which plan is right for you? It all comes down to preference. If you value cost savings and don’t mind following a referral process, an HMO might be a good fit. However, if you prefer the flexibility to see an in-network specialist without a referral, an EPO could work better for your needs.
If you have any questions about an HMO EPO plan comparison or would like to find a plan that works for you, contact us at Health Benefits Associates. Our experienced agents would be happy to walk you through the options to find the best fit for your budget and goals. Schedule an appointment by calling 775-828-1216 today. We look forward to hearing from you!