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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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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

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