HMO, PPO, and EPO. What Is The Difference?

You’ve probably heard the terms HMO, PPO, and EPO. We created a simple side-by-side chart that shows the basic features of HMOs, PPOs and EPOs. Please note, there is no right or wrong choice when it comes to selecting your health care plan, it’s more of a preference, not a wrong or right choice. Do you prefer to eat an apple or banana? It’s a preference. Having a clear understanding of these plans and how they work will help you in choosing the plan that’s best for you, your family, and your budget.

What is a PPO?

PPO stands for Preferred Provider Organization. A PPO health insurance plan allows for more flexibility and more choices when it comes to your healthcare. It offers a network of healthcare providers to choose from and you have the freedom to receive care from within that network or choose an out-of-network doctor, specialist, or hospital, without a referral. Keep in mind, however, that your out-of-pocket medical costs are lower when you choose an in-network provider but overall, out-of-pocket costs are higher with PPO Plans.

Flexibility

PPO plans do not require you to choose a Primary Care Physician (PCP) and do not require referrals. Let’s say you have a doctor or specialist that you like and have been seeing for years. With a PPO plan you could continue your visits whether they are in-network or out-of-network and without the need for a referral. If your PPO plan has a nationwide network of doctors, you can go anywhere in the USA. Check your plan details for more info.

It is important to remember that while you can receive care from any doctor, specialist, or hospital you choose, you will save more money by choosing an in-network provider.

Higher Monthly Premium

(and hard to find since the ACA was passed)

The greater flexibility of a PPO often comes with a higher monthly premium, co-pays, and other costs too. While you can choose to use doctors, specialists, or hospitals outside of your network, finding health plans that are PPO in Nevada have been in short supply since the passage of the ACA. Please call us for the latest on availability of PPO Plans in Nevada. We have several EPO plans now available that work like PPO Plans.

What is an HMO?

HMO stands for Health Maintenance Organization. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All your care is coordinated through that PCP. HMO plans won’t cover out-of-network care except in an emergency.

Lower Cost

With an HMO plan, your out-of-pocket medical costs and monthly premiums will generally be lower than a PPO.​

Selecting a Primary Care Physician (PCP)

With an HMO plan, you’ll select a Primary Care Physician who will be your contact for all your healthcare, and they will connect you to specialists or other health care providers.

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What is an EPO?

EPO stands for “Exclusive Provider Organization.” An EPO is a type of health insurance plan that offers a local network of doctors, specialists, and hospitals in your area for you to choose from. These plans are among the most affordable options with generally low monthly rates and many of the plans contain co-pays before the deductible.​