What's the difference between HMO, PPO and EPO?
HMO
You always see your primary care provider first, who refers you to specialists within a specific medical group. You cannot get care outside the medical group or the plan’s network unless it’s an emergence.
PPO
You do not have to have a primary care provider and you don’t need referrals to see a specialist. You can go to any provider in the plan’s network. You can go outside the plan’s network but the costs may be significantly higher.
EPO
This is sort of a hybrid between an HMO and a PPO. Like a PPO, you do not have to have a primary care provider and you can see a specialist without a referral. But like an HMO, you cannot go outside the plan’s network (except for emergency).
Neil Steinman is the principal of Orange County Health & Life Insurance in Orange County, CA – and has been serving the needs of California residents for nearly 20 years.