So what is EPO?
The insurance period has been open for a while, but there are still people who have not purchased the policy. It’s not because I don’t want to buy it, but I’m very entangled in what insurance I should buy and what plan to choose, and I always don’t know which one is best for me. After all, seeing a doctor is not a trivial matter, and medical expenses are expensive. Buying a cost-effective insurance policy has naturally become a topic that everyone is eager to discuss. Then today, the Panyu Health Insurance Department gave us a very detailed explanation, so that after reading it, everyone can avoid the minefield.
What is an HMO plan?
A Health Maintenance Organization (HMO) is a network of hospitals, doctors, and other health care providers, and many HMO providers charge a fee per member, regardless of the number of visits a member sees. This makes HMO plans more economical than PPOs.
HMOs generally only cover care received from a plan’s contracted health care facility (called an “in-network” provider). When you are covered through an HMO, you need to choose a Primary Care Physician, a PCP physician, usually, a family physician, internist, or pediatrician, to manage your care and refer you as needed To specialists in the network.
Advantages of HMO Programs:
If you are budget-conscious or have fewer doctor visits, an HMO may be more suitable for you.
- The monthly premium is relatively low, and the proportion of out-of-pocket expenses for general patients after seeing a doctor is also low.
- Since you’ll get medical care in-network, you’ll have fewer chances to file a claim on your own.
- Your healthcare practitioner is familiar with your overall health and can coordinate treatment.
Disadvantages of HMO plans:
- HMO plans require you to only use the network of doctors and hospitals within the network, with few options for medical care, except for medical emergencies.
- Patients must be referred by a family medical practitioner before they can see a specialist or be hospitalized, which can sometimes delay the patient’s treatment.
- If your current doctor is not part of the HMO network, you will need to choose a new doctor.
What is a PPO plan?
A Preferred Provider Organization (PPO) gives you greater flexibility to book an appointment directly with a specialist, saving you time. When you visit a medical facility in the network, you can get discounted rates for members. PPO members can also choose out-of-network medical institutions (out-of-network providers), but the proportion of personal out-of-pocket expenses is much higher. Also, you cannot get discounts on medical services when you see a doctor at a medical institution outside the network, so the cost of medical treatment is higher.
Advantages of PPO plan:
If you need flexibility in choosing healthcare providers, a PPO plan may be a better option than an HMO.
- There is more flexibility in using medical institutions and more rights to choose doctors and hospitals.
- Policyholders do not need to appoint a family doctor, nor do they need to be referred by a primary care physician to see a specialist.
Disadvantages of PPO plans:
- The monthly premiums and out-of-pocket costs are usually higher than those of HMO plans.
- In the absence of a primary care physician, the responsibility for managing and coordinating one’s own care is greater.
Are HMOs better than PPO plans?
The decision between an HMO and a PPO is based on which factor is most important to you: cost or flexibility. If cost reduction is important and you don’t mind choosing a doctor from an HMO network, an HMO plan may be for you. If you already have a team of doctors or specialists you want to continue seeing, but they are not in your HMO plan network, a PPO plan may be right for you.
Other types of health plans
Although HMO and PPO plans are the two most common, you should also be aware of other plan types such as EPO plans.
In terms of flexibility and cost, the Exclusive Provider Organization (EPO) EPO program sits between the HMO and the PPO. With an EPO, you usually don’t need a referral to see a specialist, which makes it more flexible than an HMO. However, like HMOs, there are no out-of-network perks. Some of the cheaper EPO plans have a smaller network of medical services, with limited choices of medical facilities such as hospitals and clinics.
Having said so much, if you still have questions, we have also summarized these contents for you. In the table below, you can clearly see the advantages and disadvantages of the three insurance plans mentioned above, allowing you to more intuitively Find the desired option.