Difference Between PPO and EPO

Health care plans are an inevitable part of our lives. However, it may be confusing to make the right choice out of a multitude of options available to everyone.

PPO and EPO are two such health care plans that provide services at subsidized rates to consumers. However, they have several varying features and characteristics. 

PPO vs EPO 

The main difference between PPO and EPO is that PPO offers is relatively more flexible in nature. Thereby, PPO plans allow users to access both in-network and out-of-network health care providers. On the other hand, EPO plans are restrict the plan holders because plan holders of EPO can access only in-network healthcare providers. 

PPO vs EPO

PPO stands for a health care insurance plan that consists of doctors, and other health care providers. The main aim of PPO is to ensure that the plan holders get medical services at rates that are significantly lower than the market rates.

PPO plans eliminate the need to choose a primary care doctor. PPO plans also don’t require referrals to get prescriptions from a specialist.

EPO refers to a health insurance plan which eliminates the need of a primary care provider. However, EPO plans necessitate the need to visit health care providers within the pre-set network.

EPO plans charge plan holders only for the services that are utilized. Speculations suggest that EPOs were in existence from as early as 1983.

Comparison Table Between PPO and EPO 

Parameters of ComparisonPPOEPO
Full FormPPO refers to a preferred provider organization.EPO stands for Exclusive Provider Organization.
Definition PPO refers to a health insurance plan composed of doctors, and other health care providers.EPO refers to a health insurance plan which eliminates the need of a primary care provider.
CostsPPO generally costs more than EPO.EPO is a cost-effective plan. 
NaturePPO offers a wide plethora of services to its plan holders.EPO plans are limited to some specific services. 
Area of Coverage Plan holders of PPO can access both in-network and out-of-network health care providers. Plan holders of EPO can access only in-network healthcare providers. 

What is PPO?

PPO refers to a preferred provider organization. Other names of PPO include participating provider organization and preferred provider option.

By definition, PPO consists of doctors, and other health care providers. The main aim of PPO is to ensure that the plan holders get medical services at subsidized rates. 

PPO provides several services to its users. The most prominent out of these is the utilization review.

Other facilities include a pre-certification requirement. PPOs were organized from the early 1980 onwards.

In PPO plans, patients are provided exclusive services from any doctor, health care provider, or hospital. The plans also allow for flexibility in choosing health care professionals that are not covered in the plans.

In some instances, the cost to avail out-of-network services is usually higher than in-network services. In addition, most PPO plans cover prescription drugs as well.

PPO plans eliminate the need to choose a primary care doctor. PPO plans also don’t require referrals to get prescriptions from a specialist.

Some organizations offering PPO plans are Humana, Aetna, and Beech Street. To conclude, PPO pans offer health care services to consumers at a subsidized rate. 

What is EPO?

EPO stands for Exclusive Provider Organization. By definition, EPO refers to a health insurance plan which eliminates the need of a primary care provider.

However, EPO plans necessitate the need to visit health care providers within the pre-set network. In EPO plans, there is no provision for out-of-care service and visits require pre-authorization.  

In EPO plans, plan holders pay in proportion to the facilities availed by them. In addition, EPO plans follow a payment for service policy.

Evidently, plan users pay only for those services that they avail. Speculations suggest that EPOs were in existence from as early as 1983. However, EPO plans initially were an extension for PPO plans. 

EPO plans are significantly restrictive as they offer only some limited health care services to plan holders. In addition, EPO plan holders have to pay entire costs to avail services of out-of-network doctors.

However, one significant advantage of enrolling in EPO plans is that they are relatively more cost effective when compared with other plans. 

EPO plans don’t cover any emergency services that are outside their provisions. Additionally, there are rigid rules that make it difficult for an individual to switch from an EPO plan to any other plan.

Thus, EPO can be classified as a cost effective health insurance plan that is significantly restrictive in its choice of services provided. 

Main Differences Between PPO and EPO 

  1. PPO refers to a preferred provider organization. In contrast, EPO stands for Exclusive Provider Organization.
  2.  PPO comprises of medical doctors, hospitals, and other health care providers. On the other hand,  EPO is a health insurance plan which eliminates the need of a primary care provider.
  3. PPO plans generally costs more than EPO plans. On the other hand, EPO plans are cost-effective in nature.
  4. PPO offers a wider plethora of services to its plan holders as compared to EPO plans..
  5. Plan holders of PPO can access both in-network and out-of-network health care providers. In contrast, plan holders of EPO can access only in-network healthcare providers. 
Difference Between PPO and EPO

Conclusion

Thus, PPO and EPO are both health care plans that offer varying costs, features, and areas of coverage. In PPO plans, patients are provided exclusive services from any health care professional.

The plans also allow plan holders to choose doctors or health care providers that may be outside the plans.

EPO plans are restrict the plan holder to health care professionals within its provisions. In addition, EPO plan holders have to pay entire costs to avail services of out-of-network doctors.

To conclude, PPO and EPO have considerable differences. 

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