Irrespective of your health condition or medical history, purchasing a comprehensive health insurance plan is beneficial. This is because health insurance covers the cost of routine care such as yearly checkups, hospitalization, emergency procedures, drug prescriptions, and other health-related expenses. It protects the policyholder from going out of pocket for health expenses. However, there are several types of health insurance offered by various health insurance companies. One of these is EPO health insurance.
EPO health insurance is a type of health insurance that covers the cost of medical care but only from hospitals and doctors within its plan’s network. Each time a policyholder gets a medical treatment in-network, EPO health insurance covers a part of the medical bill while they pay the rest out-of-pocket. How much they pay depends on the deductible, out-of-pocket max, and coinsurance. A deductible is the upfront payment required before your health insurance kicks in.
How Does it Work?
An EPO health insurance allows policyholders to get medical treatment from health facilities and health providers that are partners with the health insurance company. These providers and facilities are classified as “in-network.”
This insurance company pays these health providers a specific amount for medical treatment and services. In in-network care, this insurance pays the biggest amount towards the cost of medical care while the policyholder pays the balance left in the form of a deductible.
Should I Get EPO Health Insurance?
This insurance may be a good idea if you do not want to go through the stress of getting referrals and would like to manage your medical care without the help of a primary healthcare provider. This insurance may be a good idea if you need an insurance plan with flexibility but do not want to pay higher premiums for a PPO health insurance plan. Note that the EPO health coverage plan does not offer coverage for out-of-network care.
How much does it cost?
The average cost for EPO health insurance per month for a 30-year-old is $436. However, based on the age of the policyholder, EPO offers health insurance plans at different costs. The table below illustrates how much this health insurance plan costs by the age of the policyholder.
| Health Insurance Plan Policyholder by Age | Average Cost for EPO Health Insurance Per Month |
| Age 0-14 | $286 |
| Age 18 | $334 |
| Age 21 | $380 |
| Age 27 | $405 |
| Age 30 | $436 |
| Age 40 | $490 |
| Age 50 | $685 |
| Age 60 | $1,037 |
| Couple age 21 | $761 |
| Couple age 30 | $872 |
Depending on your age, EPO offers health coverage for several costs. However, some factors may affect your health insurance cost; these factors include medical history, health condition, and habits.
Advantages and disadvantages of EPO Health Insurance
While this health insurance plan is one of the best, there are benefits and drawbacks to EPO Health Insurance. These help you identify if purchasing an EPO health plan is a good idea for you or not. However, the following are the advantages and disadvantages of this insurance.
Advantages:
- Affordable monthly premiums.
- No referrals are required.
Disadvantages:
- High out-of-pocket payments.
- Out-of-network medical care is not covered.
While you may have a health provider that is not an in-network provider, EPO will not offer coverage for treatments except if it is an emergency.
Does EPO Health Insurance Require a Referral to See a Specialist?
EPO does not require a referral from its policyholders to see a specialist. Policyholders can make appointments and select what specialist they want without supervision from a primary healthcare provider. However, policyholders are only allowed to select an in-network specialist.
What If I Need to be Admitted Urgently?
If you need emergency medical care, EPO will offer coverage for it. It covers the medical bills irrespective of whether it’s an in-network or out-network provider. However, if you visit an out-of-network provider, you will be required to pay more on out-of-pocket payments than you would for an in-network provider. In cases where it is not an emergency, you will be required to pay out-of-pocket for your medical bills.
Differences between EPO and Differences
The PPO health insurance plan offers flexibility to policyholders to see any doctor of their choice, irrespective of whether it is in-network or out-of-network. It pays more for medical care for in-network and less for out-of-network care. Unlike EPO, PPO health insurance requires policyholders to get a primary care provider or a referral to meet a specialist. EPO health insurance is more affordable than PPO health insurance.