HMO, PPO or EPO — Which plan is right for you?
As if medical insurance couldn’t get any more complicated, there are three different types of plans to choose from — EPO, HMO, & PPO. The question is, which one is the right plan for you?
Health Maintenance Organization (HMO): A Budget-Friendly Plan
HMO (Health Maintenance Organization) individual plans are another type of health insurance plan available in Florida for individuals seeking coverage. These plans typically have lower monthly premiums compared to PPO (Preferred Provider Organization) plans, but offer less flexibility in terms of choosing a healthcare provider.
Under an HMO plan, policyholders are typically required to choose a primary care doctor (primary care provider) who acts as their main point of contact for all medical needs. This doctor(primary care physician pcp) will then refer the policyholder to specialists or other healthcare providers as needed.
Most HMO’s require referrals to seek care for out of network doctors and hospitals.
HMO plans have a limited network of healthcare providers, and policyholders may have to pay full cost for services received outside of this network.
The only time you can seek healthcare for out of for out of network benefits is for emergency care. On most ACA Health Plan types this would be considered “in-network.”
Because of how limited some hmo’s network can be its advised for individual to only see in network providers. In network care for medical expenses in the HMO network will cost less money and have less out of pocket costs than either PPO, EPO. Traditionally HMO’s(Health Maintenance Organizations) do not have out of network coverage/out of network care.
HMO plans are often more affordable than PPO plans and can be a good option for those who are looking for low-cost health insurance and are willing to sacrifice some flexibility in exchange. If you need to see a specialist make sure the doctors are in network. If you have quality standards in terms of doctors, hospitals or don’t want to deal with an out of network provider we recommend either an PPO, EPO.
Preferred Provider Organization (PPO): The Plan with the Most Freedom
PPO (Preferred Provider Organization) individual plans are a type of health ins option available in Florida for individuals who are seeking coverage. These plans typically provide more flexibility in terms of choosing a healthcare providers/health services compared to HMO (Health Maintenance Organization) plans. Under a PPO health plan, policyholders can visit any healthcare provider they choose, but may pay more out of pocket for visits to out-of-network providers. Comparing an EPO vs PPO you will find the PPO plan has higher premiums.
Additionally, PPO plans usually have a network of preferred providers who offer services at a discounted rate to policyholders. These plans also typically offer more comprehensive coverage options, such as coverage for prescription drugs and mental health services. You do not need a referral from a primary care physician to see a specialist with a PPO plan.
In general you will find the PPO’s network to be larger than either an HMO or EPO. This includes a POS plans. If you travel and have specialists and doctors in many states a PPO plan would make most sense.
Overall, PPO individual plans can be a good option for those who value flexibility and comprehensive coverage in their insurance. If you are worried about out of pocket costs or out of network services a PPO would be best for you. A PPO allows for more freedom and a larger network.
An example of a PPO health plan here in Florida would be Blue Blue/Blue Shield Blue Options.
Exclusive Provider Organization (EPO): Larger Networks to Make Life Easier
EPO (Exclusive Provider Organization) individual plans are a type of health insurance plan available in Florida for individuals seeking coverage. EPO plans offer a compromise between the flexibility of PPO plans and the cost savings of HMO plans. Unlike PPO plans, EPO plans have a limited network of healthcare providers that policyholders are required to use in order to receive coverage.
Compared to HMO plans, EPO(Exclusive Provider Organizations) plans offer more flexibility as policyholders do not need a referral from a primary care physician to see a specialist. Remember you still need to stay in-network for doctors and a specialist.
Additionally, while policyholders will typically pay more out of pocket for visits to providers outside of the EPO plan/network, they may still have more options than they would under an HMO plan. Overall, an EPO plans can be a good option for those who are looking for a balance between the cost savings of an HMO and the flexibility of a PPO in their health plan.
An example of an insurance company in Florida that offers an EPO plan would be Cigna.
Cigna EPO health plans do not have out of network benefits. But because its an EPO plan you do not need a referral from your primary care physician.
The health insurance marketplace has a myriad of health plans that are HMO, EPO and PPO. You wll have higher costs for the EPO and PPO plans. In Florida, Florida Blue Options has the highest costs for a PPO. HMO Plan types Aetna, Ambetter, Molina and Florida Blue HMO will have lower costs than an EPO or PPO plan. Cigna is our pick for top EPO plan in 2023.
For questions on an EPO vs PPO or about an HMO Health policy please give us a call at 954-282-6891. Our agents are waiting to help you today!
