HMO vs. EPO

Difference Between HMO and EPO

HMO and EPO are both projects of health insurance. HMO represents Health Maintenance Organization and EPO is the Exclusive Provider Organization. Several technical differences exist between EPO and HMO.

The HMO can be regarded as a product which is insured, which refers to the fact that the claim will be paid by the insurance company, where as, EPO can be called as a self-insured product where the employer must pay the price.

From the point of flexibility, Exclusive Provider Organization is more flexible than the Health Maintenance Organization. For the insurance of the Health Maintenance Organization, a referral from the Primary Care Doctor is required. PCP is the head of all medical services and provides referrals. In contrast, for the inurance of Exclusive Provider Organization, there is no need for a referral to a doctor in primary care.

An HMO also requires that the insured person remains in the network of providers. It’s the same with the insurance of  EPO, so there is no out of network coverage for both insurance plans.

An HMO plan usually has a vast network of doctors, while the EPO has only a limited network of doctors.

By comparing the premiums, EPO has a lower premium than the HMO. The HMO is determined on a capitated basis, while the EPO is based on the services provided. Considering their coverage, the EPO is more appropriate for rural areas.

The Health Maintenance Organization is regulated in accordance with laws and regulations of HMO. The act of Retirement Income Security of Employee regulates Exclusive Provider Organization.

Summary:

1. The Exclusive Provider Organization is more flexible than the Health Maintenance Organization.

2. In the assurance of the Health Maintenance Organization, a referral from the Primary Care Doctor is required. A referral from a Primary Care Doctor is not necessary for  EPO insurance.

3. HMOs can be called as an insured product, which means that the insurance company will pay the price of the claim. EPO can be called as a product of self-insured, the employer must pay the price.

4. By comparing the premiums, EPO has  lower premium than the HMO.

5. Plan Health Maintenance Organization usually has a vast network of doctors, while the Exclusive Provider Organization has only a limited network of doctors.

6. Unlike the HMO, EPO is better suited for rural areas.

 

 

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