EPO vs. PPO

What is the difference between EPO and PPO?

Two popular health plans that are available in the United States are Exclusive Provider Organization (EPO) and Preferred Provider Organization (PPO).  The cost of health care in the US is rising every year and it makes good financial sense to have medical insurance at the best possible premium prices. In addition to finding the best prices, you also have to look at what the insurance provides because the cheapest may not always be the best one to choose. When comparing EPO and PPO you need to take a good look at the features of each to determine the benefits and drawbacks so that you can be a more informed consumer.

About PPO

In the Preferred Provider Organization medical insurance plan each insured member has a list of physicians to choose from. They can only visit doctors that are on this list to have the visit covered by the insurance policy. However, the patient has to pay the cost of the treatment upfront and then submit the bills to the insurance organization to be reimbursed. Patients are free to seek medical treatment outside the network, but all of the costs associated with the treatment may not be covered. This means that there will be a portion of the cost that will not be reimbursed.

About EPO

This is basically the same as the PPO with the exception that the insurance will not pay for any medical treatment received from physicians or health care institutions that are not part of the network. In agreeing to become a member of this organization, patients are bound to accept treatment within the network.

PPO vs. EPO

It is important to understand how PPO and EPO are different from each other before you make your selection. First you should take a close look at what your needs are when it comes to medical insurance. The coverage you receive under the plan is just as important as the cost of the premiums.

A PPO is usually operated by a team of doctors and health care organizations. They charge patients a premium for the coverage they offer in insurance, which is through a third party insurance provider. This provides very cost effective health care because members usually receive discounts.

The PPO plan is more flexible in that patients are not bound to seek medical treatment from only those doctors and organizations that are part of the network. This is not the case with EPO and the fees charged by specialists in the organization are often higher than it is in the PPO.  For those who enroll in EPO, the doctor recommends a specialist and the patient has no other choice by to accept this recommendation if he does not want to pay the full cost of the visit.