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February 24th, 2015

HMO vs. PPO

by Dr. Jordan Leasure

Knowing the differences between medical insurance plans will help you choose the one that’s right for your health care needs.

 PPO stands for preferred provider organization

 EPO stands for exclusive provider organization.

Both plans use a network of physicians, hospitals and other health care professionals. The difference between them is the way you interact with those networks.

PPO plans give you more flexibility. You don’t need a primary care physician and you can go to

any health care professional you want without a referral—inside or outside of your network.

Staying inside your network means smaller copays and full coverage. If you choose to go outside

your network, you’ll have higher out-of-pocket costs, and all services may not be covered.

EPO plans combine the flexibility of PPO plans with the cost-savings of HMO plans. While you

do not need to choose a primary care physician with your EPO plan and you don’t need referrals

to see a specialist, you will have a limited network of doctors and hospitals to choose from. EPO

plans will not cover care you get outside your network unless it’s an emergency.

If you want greater flexibility or if you see many specialists, a PPO plan might be what you’re

looking for. But, if you’re interested in saving money by using a smaller network of doctors and

hospitals, an EPO plan would work for you.

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