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EPO Plans vs HMO, PPO, and HSA Plans

An Exclusive Provider Organization (EPO) health insurance plan is one of the America's "managed care" system offerings. It involves a network of medical care providers, which provide healthcare to the subscribers of the health insurer, wherein the subscribers are required to chose a primary care physician from within the network. EPOs are beneficial because of their cost effectiveness, since the insurer can negotiate low premiums and co-payments with their providers based on the guarantee that policyholders will visit network doctors only.


A PPO plan is similar to an EPO plan; however PPO members can avail reimbursement for availing services from medical care providers other than the designated medical providers. However reimbursements are at a reduced rate, which may include higher deductibles, co-payments, lower reimbursement percentages, or a combination of these disadvantages. Some EPOs allows partial reimbursement outside the network in emergency cases.


In HMO plans, as with an EPO, choosing an out-of- network medical provider, implies the entire payment of the provider's bills. On the other hand, EPO rates are negotiated based on services whereas HMOs are determined per-person basis; HMOs receive monthly payments from carriers while EPO providers are only paid for services provided; and premiums for HMOs are generally more expensive than EPOs.

EPO vs. Health Savings Accounts (HSA)

An HSA plan is a combination of a high-deductible insurance plan and tax-favored savings account. As compared to an EPO plan, it has tax benefits and lower monthly premium rates associated with it.

EPOs, though cost effective, are quite restrictive since the network of doctors is usually smaller than in HMOs and it is nearly impossible to see an out-of-network provider without paying the entire medical fees from one's own pocket

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