Q:

Is EPO or PPO better?

A:

When it comes to choosing health insurance, there really is no “right” choice for everyone. Neither EPOs nor PPOs are better than the other. It is about what an individual needs when it comes to his health care provider. EPOs and PPOs are somewhat similar; both plans allow the freedom to see a specialist without a referral. However, according to About, with an EPO all expensive services must be pre-authorized.

Pre-authorized services include hospitalization, surgery, CT scans and MRIs. In some cases a doctor may offer to help with the pre-authorization, but it is generally left up to the patient. Without pre-authorization an EPO may not pay for expensive procedures at all. They also do not pay for out-of-network services. The only exceptions are for emergency or urgent care.

PPOs usually have higher premiums than EPOs because they offer a wider network of doctors and specialists. There is also the option to go out-of-network, though there may be an out-of-pocket cost. The benefits may also decrease when using an out-of-network service. There are three main types of health plans: EPO, PPO, and HMO. EPO stands for exclusive provider organization. PPO means preferred provider organization, and HMO represents health maintenance organization.

Learn More

Related Questions

  • Q:

    What does "coinsurance after deductible" mean?

    A:

    Coinsurance after deductible refers to the amount of the bill a consumer is responsible for once the insurance deductible has been met. For example, in a 70/30 coinsurance after deductible plan, the consumer pays 30 percent of the cost of medical services and the insurance company pays 70 percent.

    Full Answer >
    Filed Under:
  • Q:

    What are some of the goals of health care reform?

    A:

    In the United States, some of the goals of health care reform are to significantly increase the number of individuals who have access to primary health care, control the growth of health care expenditures and enable individuals with pre-existing conditions to obtain comprehensive health care insurance coverage. The passage of legislation in March 2010, commonly referred to as the Affordable Care Act or the ACA, was an attempt to achieve these goals while also lessening the burden of the increased uncompensated health care costs suffered by hospitals as a result of the recent U.S. economic recession. It is believed that the ACA will help reduce the cost of major health care interventions by enabling more than 30 million previously uninsured individuals to obtain timely primary health care and not delay needed treatment.

    Full Answer >
    Filed Under:
  • Q:

    What are eye doctors that accept Medicaid?

    A:

    The best way to find an optometrist or ophthalmologist who accepts Medicaid payments is to search the Physician Care page on Medicare.gov, the U.S.government's official Medicare website. To conduct a search, type the city, state, ZIP code and specialty into the search fields. This brings up local area eye doctors. Look for a graphic box with the letter "m" in the middle, which indicates that the doctor accepts Medicaid.

    Full Answer >
    Filed Under:
  • Q:

    What are the Consumer Report's top picks for auto insurance providers?

    A:

    In its published review of October 2010, Consumer Reports rated Amica, Auto-Owners, NJM and USAA among the top tier of auto insurance providers. These four companies scored 92 percent out of 100 in overall customer satisfaction. The full report includes ratings for 22 major insurers that handle auto claims.

    Full Answer >
    Filed Under:

Explore