Difference Between EPO And PPO

The difference between EPO and PPO is that EPO is the abbreviation of “Exclusive Purchasing Organizations” and PPO stands for “Preferred Purchasing Organizations”. Both are two different types of health insurance. PPOs cover services both inside and outside the plan provider network. EPOs only cover services provided by the provider network.

Do You Know The Difference Between:

What is Health Insurance?

Health insurance is a type of insurance that protects against the risk of paying for medical expenses. Under health insurance, the insured pays a premium each year in return for which the insurance company pays the insured’s medical expenses if and when they may be covered during the period.

However, these health insurances, like other insurances, have special conditions. For example, insurance may only cover certain types of illness, specific types of medical care, or certain hospitals. The insurance company can also pay all medical bills in full or only part of the amount owed.

There are four main types of health insurance available to the public: HMO, PPP, EPO, and POS.

  • HMOs are health care organizations
  • PPOs are preferred service organizations
  • EPOs are proprietary service organizations
  • POS are service programs

What is PPO?

PPO, or Preferred Provider Organization, is a health plan that includes a large network of more doctors and hospitals to decide from. Your output is generally higher with PPO than with HMO or EPO.

If you are able to pay a higher monthly premium to gain more choice and flexibility in selecting a doctor and health care options, you must select the PPO health plan. Under the plan, the insured can consult with any physician, whether or not they are part of the provider network.

What is EPO?

An EPO, or Exclusive Provider Organization, is a health plan that offers a network of local doctors and hospitals to select from. An EPO plan is normally more flexible than a PPO. However, if you wish to get out-of-network care, then it’s not possible in it (except in emergencies).

If you are looking for a less monthly premium and want the health care facilities, you may want to consider an EPO plan. They usually do not cover the services provided by doctors and hospitals outside the plan provider.

Difference Between EPO And PPO
Difference Between EPO And PPO

Difference Between EPO And PPO

EPO and PPO are two different types of health insurance. In the United States, the cost of medical care is very high. Therefore, providing health care is a difficult task for most citizens. Here are some most common differences between EPO and PPO.

EPOРРО
AbbreviationExclusive Provider organizationsPreferred Provider Organizations
CategoryHealth insuranceHealth insurance
Services IncludesMost EPO programs include primary medical care, preventive care, emergency care, and long-term, specialized care such as surgery and physiotherapy.Most PPO programs include primary medical care, preventative care, emergencies, and long-term, specialized care such as surgery and physiotherapy.
Insurance paymentsLess than PPO.higher than EPO
TherapistNo requirement for primary care.No requirement for primary care.
Out of Network CoverageOut-of-the-network care is not provided, except for emergency care.Coverage provided inside and outside the plan provider network.
DirectionsThere may be no need to refer to a specialist.There may be no need to refer to a specialist.
Prior AuthorizationPrior permission is required for certain types of medical services, such as surgery or hospital visits.Advance permission is required for specific types of medical services, such as surgery or hospital visits.
Co-FinancingAffordable sharingThe high share of costs, especially for out-of-network care
InquiryThere is no need to provide claim documents.You must submit documents for claims, but only for offline claims.

Final Words

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