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. PPO , which win?
EPO vs PPO reviews
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
- There is no need to choose a primary care physician with a PPO program, so that gives employees a little bit more flexibility when choosing healthcare.
- Employees also have the option of going out of network for care as well, which is not an option in some other types of plans.
- One of the biggest benefits is that there is very little paperwork for both the employee and the employer.
- For employees, a PPO is one of the higher cost options. That does not necessarily mean the employer will pay more, but it could have that implication.
- Employees may need pre-authorization for certain types of care, and this might be something that the employee would have to handle themselves.
- If the employee needs to move out-of-network, then costs can add up quickly.