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.


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