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Thatch details the key differences between PPO and EPO health insurance plans.
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
PPO. The Preferred Provider Organization plan is the most popular for those with employment-based insurance (currently 47% of them, in fact). PPOs allow the most flexibility in that people can ...
By 2007, an estimated 3.8 million U.S. workers, about 5% of the covered workforce, were enrolled in consumer-driven plans. About 10% of firms offered such plans to their workers, according to a study by the Kaiser Family Foundation. [6] In 2010, 13% of consumers in employee-sponsored health insurance programs had consumer-driven health plans. [7]
The deductible must be paid in full before any benefits are provided. After the deductible is met, the coinsurance benefits apply. If the PPO plan is an 80% coinsurance plan with a $1,000 deductible, the patient pays 100% of the allowed provider fee up to $1,000. The insurer will pay 80% of the other fees, and the patient will pay the remaining ...
A PPO plan is comprised of a group, called a network, of healthcare providers and hospitals from which a person can choose. These providers will be cheaper than using providers outside of the network.
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
HMO plans also require a referral to see a specialist, but PPO plans do not. HMO plans do not usually offer out-of-network coverage. PPO plans may provide out-of-network coverage but at a higher cost.