EPO Medical Plans: Are They Right for Your Employees

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When it comes to medical plans, many of your employees might be more accustomed to Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans ⎼ but have you thought about offering an Exclusive Provider Organization (EPO) plan? 

We know when it comes to figuring out what types of medical plans are right for your employees, you have a lot to consider — and adding one more option can seem daunting. We want to help you sort through the details and get the answers you need to make the decision that’s best for you and your people. 

Here’s some info to help you determine if adding EPO plans could benefit your employees.

How do the plans compare?

EPO health plans only cover medical care within their network of health care providers. This concept isn’t much different from HMOs and PPOs, which also contract with a network of providers to offer lower-cost coverage in-network. 

An HMO usually requires you to get a referral from a primary care doctor to see a specialist and it doesn’t typically cover out-of-network medical care. A PPO allows for a little more freedom ⎼ it doesn’t require referrals and will often cover out-of-network medical costs but at a higher out-of-pocket expense compared to in-network.

EPO plans are a hybrid of the two. What sets the EPO plans apart is the size of their network. Typically, an HMO’s bank of doctors is within a region or state, while PPO and EPO plans are nationwide. With EPOs, you won’t receive coverage outside of your network, and you won’t need a referral to see a specialist. 

What does it cost?

Wanting to find ways to limit your health care cost and your employees’ out-of-pocket expense is understandable. EPO plans can have higher monthly costs than HMOs, but lower monthly costs than PPOs. Deductibles, copays, and other expenses vary with each plan. 

It’s good to give your employees more than one health plan option so they can make a well-informed decision about what’s right for their health care needs and budget.

If you decide to offer EPO plans, let your employees know: 

  • Out-of-network services aren’t covered 
  • They don’t need referrals
  • Where to find the list of in-network providers
  • How and why the cost varies from plan-to-plan

Learn more about plan differences with Aetna’s health guide


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