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EPO vs. HMO , which win?



Under an EPO plan, members are required to use hospitals and doctors within their own network. Much like a HMO plan, you cannot go outside of your plan’s network for care and you will not be covered if you choose to receive care from an out of network provider. One of the biggest advantages of an EPO plan is the lower cost. EPOs typically cost less than both HMOs and PPOs. Another major perk is that you do not have to get a referral from your primary care doctor to see a specialist.



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EPO vs HMO compare



Which Plan Is Best?

While EPO and HMO health insurance plans have some similarities, they have even more differences. HMO insurance is often termed as an insured product, meaning that the insurance company will pay the cost of the claim if it meets all coverage guidelines. In comparison, EPO insurance is often termed as a self-insured product in which the employer pays the costs. Another major difference between the two relates to flexibility. EPOs are typically more flexible than HMOs, as HMOs have more strict rules regarding referrals and similar features.

If you are considering your options in terms of cost for EPO vs. HMO health insurance, you will want to consider all aspects of pricing such as premiums and copays. EPO health insurance often has lower premiums than HMOs. However, HMOs have a bigger network of healthcare providers which more than makes up for it. You may also want to consider your location when choosing a health insurance plan. EPOs are better suited for rural areas than HMOs.

stressed employer trying to assemble an EPO insurance packageIf you loathe paperwork and making phone calls to the insurance company, you may want to avoid EPOs. Most EPO plans require pre-authorization of services. This means that you must get permission directly from the insurance company before acquiring various types of healthcare services. If you fail to get pre-authorization, you may be stuck paying the entire bill out-of-pocket. Pre-authorizations are put in place to ensure that you are only receiving services that are medically necessary.

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EPO vs HMO reviews

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comparman EPO

Pros of EPO:

  • Low monthly premium payments
  • No or low deductibles, coinsurance, and copayments
  • You do not need referrals

Cons of EPO:

  • Fewer provider choices
  • Requires pre-authorization
  • Plans are harder to find

comparman HMO

Pros of HMO:

  • Premiums are typically low
  • Easy to find healthcare providers
  • Cash rewards and other perks are often offered

Cons of HMO:

  • Must choose a primary care doctor
  • Need a referral to see a specialist
  • Cannot use out of network providers


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