With a PPO, members have access to out-of-network providers. When you’re sick and need to see a specialist, you don’t want paperwork to slow down your diagnosis and treatment. Both an EPO and PPO may not require referrals for in-network and out-of-network services, which can offer significant time savings. Of course, the PPO members will pay a higher premium for this option. In cases where the plan has a significant number of in-network providers, members may have a generous amount of options for themselves and their family’s health care. Unlike the EPO, where members are strictly held to a more narrow selection of health care facilities, physicians, and pharmacies, the PPO allows some coverage for out-of-network providers. The EPO not only limits providers but can spread them across vast regions.Īn advantage of a PPO over an EPO is that out-of-network providers are available. A PPO might be better for people in rural areas where driving times between doctor’s appointments and home are already long. Members may also pay a smaller copayment for office visits, outpatient care, and inpatient procedures with an EPO because they have fewer options. However, Members will pay a higher out-of-pocket cost for using providers outside the network. In comparison, a PPO offers coverage for both in-network and out-of-network providers and facilities. For example, members can only use hospitals, doctors, imaging facilities, and pharmacies contracted by the EPO. A wrong decision can cost money, time and lead to insufficient medical coverage.Īn EPO or exclusive provider organization restricts members to specific providers, facilities, and other medical services. ![]() Additionally, it’s easy to make a mistake. With so many insurers, plans, regulations, and savings programs, it’s challenging to decide on the best-managed care plan for you and your family. These are both types of health insurance coverage. You’re here because you’re wondering about the difference between an exclusive provider organization and a preferred provider organization, or EPO Vs.
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