PPO & EPO Medical Plans

Under a Preferred Provider Organization (PPO) plan arrangement , an insured has the flexibility and freedom to use almost any medical provider desired, which is what makes this plan type so popular. PPO's are simply subscription based services which charge insurers a fee to access their network of medical providers on behalf of their members, and the insurance company can then pass on the savings to these insureds in the form of lower copayments and cost shares for using these in-network providers. Out of network providers are still generally covered , but usually at a higher cost-share for the insured.

This is in contrast to EPO (Exclusive Provider Organization) medical insurance plans, which would not cover any medical services for out-of-network provider visits at all. But similar to PPO plans, EPO plans do not require referrals to specialist doctors, and will pay as long as the doctor is on the EPO network list. PPO plans would cover out-of-network specialists with no referral needed, but at a higher out-of-network cost share.

Due to the freedom and flexibility afforded, and all other things being equal for a similar benefit schedule, PPO plans would generally cost more than EPO plans, and EPO plans would cost more than HMO plans. The type of plan choice that is right for you will depend on a number of factors, including need for specialty care doctors and affordability considerations.

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