If you've been keeping up with all of the recent and forthcoming health insurance industry changes, you may have come across a term that was brand new to you. EPOs, or Exclusive Provider Organizations, have actually been around for years. In light of ongoing premium increases and large network PPO plan cancellations, however, the general public has understandably gone out of its way to learn about new and unfamiliar coverage options.
So what is an EPO, you might be asking? We'll get into the specifics later, but for now, think of an EPO as being a step above HMOs and a step below PPOs. It's a more affordable option compared to PPO plans, and one that does not require you to select a primary care physician; nor does it require that you obtain a referral before seeing a specialist. The trade-off is a limited network, which might not work--geographically, or if you're loyal to a specific provider.
Let's review some of the key features and characteristics of EPO health insurance plans…
Lower Monthly Premiums
Across the board, EPOs tend to be less expensive than their PPO counterparts. Of course, you will be limited to seeing doctors and specialists who are within a more refined coverage network, as they do not provide any coverage for out-of-network services. If you don’t have primary care doctor and this is not an issue to you, an EPO might be a good option - especially if lowering your monthly premiums is a top concern.
Refined Specialist Network
This is a big one for many people, especially those who have been seeing the same healthcare providers for years. For some, their specialist may be part of the EPO network, but it's important to verify this before seeking treatment. If for some reason you're forced to see a specialist outside the EPO provider network, you will be responsible for all costs.
Choosing a Primary Care Physician
While most PPOs require their customers to select a primary in-network provider, EPOs are a bit more flexible. You're can visit any doctor or specialist within the stated network, something that has made them very popular among those who are not especially picky about who they see. Another perk is that you don’t need to get a referral when seeing a specialist. Again, just make sure they're definitely in-network.
Can an EPO Plan Lower Your Health Insurance Premiums?
They may only account for approximately 15% of all coverage plans, but don't be surprised to see these numbers rise steadily in the months and years to come. If you'd like to know more about how to lower your health insurance premiums, or have questions about new plans or renewals, Premier can help.
Call us at 800-369-0287 to speak with an agent at no cost or obligation, or write to us through our website contact page. We're conveniently located in the heart of the Lisle/Naperville business district and offer extended hours throughout Open Enrollment.