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Q: What Is an EPO Health Plan?

Asked by Anonymous on October 13, 2017

Erica Block October 13, 2017

An EPO health plan is an “Exclusive Provider Organization” plan. With an EPO (Exclusive Provider Organization) healthcare plan, your care is covered when you see a doctor in the network. If you get care from doctors or hospitals outside the network, it won’t be covered; EPOs lack out-of-network benefits. In addition, EPO plans do not require referrals in order to see a specialist.

EPOs are often described as a kind of hybrid between HMOs (Health Maintenance Organization) and PPOs (Preferred Provider Organization). Like an HMO, EPO plans do not cover care received from out-of-network providers. And similar to a PPO, EPO plans do not require that you get a referral from your primary care physician in order to see a specialist. You can make appointments directly with a specialist without having to see your primary care physician first.

EPO plans tend to be cheaper than other plan types, but they also limit policyholders to a smaller network of doctors and healthcare providers.

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