Can someone explain to me what the difference is between a PPO and an EPO regarding insurance plans?

Question

Is the only main difference the fact that you have to find someone that is in their network? We are trying to find out which insurance plan is right for us. The EPO is cheaper per month and the co-pays are a little more, however, the PPO only covers visits at 90%, and in the long run the EPO seems cheaper.

But what is the catch? Any help? Thanks in advance.

Answer 1

Hello,

There is no catch.
PPO and EPO are different products.
if you purchase PPO plan you have 75% more choice of providers. no referrals needed from primary care physician to see a specialist.
PPO you responsible for copays, coinsurance(% amount of money that you will pay), deductibles.
********************************************************************
but the EPO has VERY limited network of doctors, specialists, hospitals, labs.
EPO you just pay flat copay. no deductibles and coinsurances.

Answer 2

Well you have to decide which is better for you and your family. PPO's were origianlly started to help with families that traveled a lot. PPO's offer two levels of benefits coverage: in-network benefits and out-of-network benefits. If a member uses providers within the plan's network (in-network benefits) they receive a higher level of coverage than if they use providers who are not within the plan's network (out-of-network) benefits. This differs from an HMO or an EPO in that in an HMO or EPO out-of-network coverage is not available. So if you think you would ever need coverage for out of network benefits you should choose the PPO. It's always best to go to the insurance companies web site and look at the "find a physician" directory to see if your physician and your hospital is listed as a participating provider. This is how you will know if they are in network or not.

Answer 3

You're correct. The mail difference if the out of network option on the PPO...

The cost of insurance isn't necessarily felt in the amount of money you spend on copays or premiums, entirely.... At times the cost may not make sense. Remember, the more freedom you have, the more a plan will cost. That being said, 90% is probably cheaper than a copay.... Unless the EPO copay is $10.00 or <... Your doc's visit would have to be more than $250.00 to pay less than a $25 copay...

So, ultimately, they're probably the same 'price'

and, both plans will cover the same thing.

Answer 4

An EPO is similar to an HMO, however, the difference is....you choose your doctors and don't need referals. It's always better if you use a networked doctor in your EPO plan for the discounts, etc....but unlike an HMO, your primary care doctor isn't in charge of your life. I have UHC EPO and I love it because of the freedom...I dont' have an insurance company telling me what I can and can't have done.

I have noticed more employers are going with an EPO plan over an HMO plan....can't explain why the PPO plans are higher because you'd think the EPO would be more. Go figure.