EPO Insurance Policies: Rate Breakdown, Benefits, And Network Overview

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Navigating the plethora of medical insurance plans available can make you feel you are out to sea without a paddle. With so many options to choose from, it can be very difficult to know which plans will afford you the best coverage to meet your personal needs, and which will fail to meet the mark. In your quest for the right insurance policy, it is highly possible you have come across Exclusive Provider Organizations, abbreviated as EPOs. 

Finding affordable insurance in particular can be a feat and deciphering the less expensive options requires careful thought and deliberation to help you determine if this type of insurance is tailor-made for you, we have put together a comprehensive breakdown and examination of rates, network information, benefits, and key considerations you need to know before moving forward.

EPO Insurance Rates And Network

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Rate Breakdown


Rates for EPO insurance are usually quite a bite lower than their competitors, mostly because the plan providers have private contracts with certain hospitals, health care clinics, and doctors specifically. If you are insured by an EPO carrier, you will be given a list of these medical providers unique to your area, who comprise your approved network for any care you may require. Your covered care is limited to this network. This allows EPO insurance plans to come at a far more affordable rate.

Insured individuals can rest knowing any expenses incurred within the EPO insurance carrier’s network will be reimbursed. Options are more limited with EPO insurance, but this is the tradeoff for lower rates and compensation for care.


​Network Overview


EPO insurance plans closely align with HMO and PPO plans, but generally, offer less wiggle room than the other two. If you were to become ill anywhere outside your covered network and were forced to see an unlisted provider, you might be forced to pay the entirety of your medical bills. However, there are exceptions to this rule, and it does usually depend on the specific EPO insurance carrier you are going with.

For example, medical emergencies may be reviewed under a different light, and you could receive reimbursement with special circumstances. There is a general litmus test that EPO carriers use across the board to determine whether an out-of-network emergency causes reimbursement. If the situation involved an illness or accident which could have put your life in danger or caused permanent damage if left untreated for longer than 24 hours, they might consider offering reimbursement for some or all of the medical bills incurred.


Pros/Benefit

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Affordable Health Care And Payments


One of the primary benefits of EPO insurance is that this coverage is so very affordable. Similar to HMOs and PPOs, this health care plan provides a network of doctors and other medical providers within your localized area you can select from for any variety of medical needs you may have.

Because EPO insurance plans narrow down care options to a specific group of medical providers, patients can afford quality health care at a lower cost by negotiating higher rates of reimbursement with network approved physicians, hospitals, and clinics. This knocks down most premiums to a much more cost-effective range, allowing you to save big on your medical care without sacrificing your health. It is this quality which draws many individuals to EPO insurance plans rather than PPOs or HMOs.


​No Referral Needed


Another huge pro to EPO insurance plans is that this medical coverage rarely requires you to get a referral before seeing a specialist. As long as that physician is within your network, you can book an appointment.

Along the same lines, many EPO plans place zero limitations on your maximum lifetime insurance coverage. In simple terms, this means that even if you were to become ill and your medical bills piled up, the insurance company will not end your coverage and pay a set amount only. This is often a way for EPO insurance carriers to offset the limitations that come with having a set provider list within your area which you cannot deviate from unless a rare emergency arises.


Is It Right For You?

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Things To Consider


EPO insurance plans are an ideal solution if you are looking for affordable medical coverage options and require low rates, or are very healthy and do not expect needing to deviate from in-network providers out of your geographical area. EPO plans vary per exact carrier, so it is always a good idea to talk with the specific company you are looking into and get questions answered.

If you are unsure what a policy covers, what the exact costs for rates, deductibles and premiums will be, or how flexible your network is in case of emergency, these are queries you need answers to before signing on the dotted line. If your primary goal is to save money on your health care costs and you have no qualms about having a less flexible network of physicians and hospitals for treatment, purchasing EPO insurance may be the best course of action for you.

There is truly no right or wrong answer to whether an EPO insurance plan is best for you as it truly depends on your own financial circumstances and unique health needs. If you have specific kinds of treatments or therapies you undergo regularly, make sure the EPO plan you choose provides for that or at least offers other viable options in a network. Another thing to look out for is the emergency caveat. If it makes you nervous to know, you might manage the entirety of any medical bills incurred as the result of an emergency health situation, make sure you choose an EPO plan that is more flexible in this area.


Need To Know


The chief downside to EPO insurance plans is their limited provider network. As we mentioned previously, this is may not be an issue to your personally. You might be in excellent health or remain within your general geographical location, making it a fairly irrelevant issue.

Remember, however, that if you have an ongoing illness that requires care from a physician out of your network, you might need to consider looking at alternative options. If this is your scenario, at the very least consider a variety of EPO insurance plans and try to find a few that offer more flexibility. If you travel frequently, and the likelihood of you needing medical attention outside your network is high, consider this when choosing an EPO plan with stringent medical emergency provisions.

Alternatively, you may be in a position where you are unlikely to require the attention of a specialist and go for your regular appointments and the occasional check-up from time to time. Here, an EPO insurance plan might be exactly what you are looking for, as you will not have to pay unsightly premiums or sky-high provider rates for the occasional visit to the doctor’s office.


CONCLUSION

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Choosing the best health insurance plan for your personal financial situation and medical needs is often a lengthy process that requires much research and forethought. EPO insurance plans are a fantastic option if you will stay within a specific provider network local to the area in which you live and are interested in paying far lower premiums to maintain your coverage long-term. We hope this article has helped shed some light onto what makes EPO insurance plans so appealing to some while others may want to look elsewhere for their healthcare coverage.

As there is often no lifetime maximum on coverage with EPO plans, you will also not need to worry about losing coverage if you have a condition that increases your bills and causes additional treatment within your provider network. With your EPO insurance policy, you will receive a defined list of providers within your area you can see and whom the insurance company has previously negotiated set contracts with.

As a result, you will maintain a standard of receiving quality health care without pay astronomical rates. You can enjoy full reimbursement for visits within your provider network and have the added benefit of lower monthly rates continuously. The reassurance that any costs incurred for your healthcare are paid for and that you don't have to come up with the money before seeing a doctor or receiving treatment will give you the peace of mind that's crucial to maintaining your mental and physical health.

Whether to choose an EPO insurance plan or select one of the other offerings on the market is ultimately up to you, and based on several factors such as your present state of health, financial situation, and others. Look at your own health and financial situation, and survey whether a more limited provider network will have any negative impact on your specific needs. EPO insurance plans are a highly attractive option to anyone looking to save on rates and maximize their health care for some of the lowest monthly premiums available.

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