Is an Exclusive Provider Organization (EPO) Plan Right For You?

Key Takeaways

An EPO can be more budget-friendly than a PPO but has restrictive coverage for out-of-network care.
An EPO has higher deductibles but lower premiums than most PPOs.
If you have in-network providers and don’t want high deductibles, you may want to consider an HMO plan.
You don’t need a primary care provider for in-network referrals.

What is an EPO plan?

An Exclusive Provider Organization (EPO) is a type of health plan that offers a local network of doctors and hospitals for you to choose from. An EPO is usually more budget-friendly than a PPO plan. An EPO can have lower monthly premiums but require you to pay a higher deductible when you need health care.

Find a local Medicare plan that fits your needs

Find plans today

How does an EPO plan work?

EPO health plans are often more affordable than PPO plans if you choose a doctor or specialist in your local network. However, if you decide to get care out of your plan’s network, your medical care may not be covered, except in an emergency. An EPO plan does not require you to have a primary care provider to direct your care.

EPO v. PPO?

A Preferred Provider Organization (PPO) is a type of health plan that offers a more extensive network, so you have more doctors and hospitals to choose from. Your out-of-pocket costs are usually higher with a PPO than with an EPO plan. You are not required to have an in-network primary care provider for referrals with a PPO.

An EPO plan does not require you to have an in-network primary care provider to direct your care. Unlike a PPO, your network of providers is smaller with a PPO. Also, out-of-network care usually is not covered with an EPO. EPO out-of-pocket costs are typically less than a PPO plan but more than an HMO plan.

Are you eligible for cost-saving Medicare subsidies?

See if I qualify

EPO v. HMO?

A Health Maintenance Organization (HMO) is a type of health plan that offers a local network of doctors and hospitals for you to choose from. An HMO usually has lower premium costs than an EPO. An HMO requires you have an in-network primary care provider to direct your care and referrals. In-network care with an HMO is not as flexible as an EPO, but a higher deductible allows smaller monthly premiums.

An EPO does not require you to have an in-network primary care provider to direct your in-network care. An EPO has higher monthly premiums but provides more flexibility for in-network coverage. EPO and HMO plans have high deductibles and do not cover out-of-network care

FAQs

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.