What is EPO Insurance?

What are EPO health plans?

EPO stands for Exclusive Provider Organization. An EPO is a type of health insurance plan that only provides coverage for services when you use providers or hospitals within the network.

If you see a provider outside of your EPO network, you may be required to pay the full cost for your care. This is different from other plans that may provide you some coverage for out-of-network care. EPO plans do not offer out-of-network coverage except for in the case of emergencies. Always check the details of your specific EPO plan.

How do EPOs work?

Below is how an EPO health plan typically works:

Monthly Premiums

The plans require you to pay a monthly payment, or premium. This is common of most health plans. Premiums for EPO plans tend to be lower than many other health plans, saving you some money.

Network Requirements

EPO health plans have a network of approved providers who are contracted to offer services at a discounted rate. When you need non-emergency care, you will be required to use providers and facilities from the plan’s network for benefits to be applied. EPOs typically offer no coverage for out-of-network services. This means that if you see a provider who is out-of-network you may be required to pay the full cost of care and services on your own. For emergency care, you can go to any doctor or hospital, and your plan will still cover it. It’s important that you review your plan details for more information.

You can search for in-network providers through your health insurance company. Most health plans have an online provider directory where you can look up doctors and facilities in your network. You can visit the Cigna Healthcare public online provider directory to search for in-network facilities and providers in the EPO network.

Prior Authorization

Some EPO plans might also need you to get approval before certain medical services, tests, or procedures. This is called a prior authorization. It’s important to know check the details of your EPO plan.

What are the advantages of an EPO health plan?

There are many benefits to choosing an EPO plan.

Lower Monthly Payments

EPOs usually have lower monthly costs, which can save you money.

Direct Access to Specialists

You can see specialists without needing a referral from your primary care provider (PCP), which can make getting care easier and faster.

Quality Providers

EPOs have a network of doctors and hospitals that agree to give you care at lower prices, so you can be sure you’re getting quality care.

What are the disadvantages of an EPO health plan?

While EPO health plans have many benefits, they also have some limitations.

Network Restrictions

You can only see providers and go to hospitals that participate in the EPO network. If you prefer a specific doctor or hospital that isn’t in the network, you might have to pay the full cost yourself, or you may want to consider choosing a different health plan and network.

Higher Deductible

EPO plans tend to have a higher annual deductible, which is the amount you have to pay for covered services before your health insurance company starts sharing costs. This should be carefully considered to ensure an EPO is the right plan for you.

How do EPO plans compare to HMOs and PPOs?

EPO plans have a lot in common with HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) health plans. They are all considered to be high-deductible health plans.

When it comes to EPO vs. HMO vs. PPO plans, let's take a closer look at how they compare.

Is an EPO health plan right for me?

EPO health plans offer a good balance between saving money and having some flexibility in your healthcare. If you like the idea of lower monthly payments and being able to see specialists directly, an EPO might be a good choice for you. However, if you need more freedom to choose any doctor or hospital, or if you travel a lot, you might want to look at other options. Understanding how EPOs work can help you pick the right health insurance plan for your needs and budget.