Compare PPOs. EPOs, and HMOs
| Categories | PPO | EPO | HMO |
|---|---|---|---|
| Network | You pay less to see providers in your plan's network. These are called preferred providers. | You get covered care from the doctors, hospitals, and other providers in your plan's network. | You get care from the doctors, labs, and other providers in your plan's network. |
| Out-of-Network | You can go out-of-network, but you pay more. | You can go out-of-network, but you will pay the full our-of-pocket costs for the service. The only exception is if you have an emergency or need urgent care. | You cannot see providers out-of-network except in an emergency or if your plan gives you pre-approval. |
| Primary Care Doctor | You may not be required to have a primary care doctor. | You may not have to use a primary care doctor. | You must have a primary care doctor. This is the doctor you must usually see first when you need care. |
| Referrals | You may be able to get many health services without a referral. | You do not need to get referrals to see specialists if they are in the EPO's network. | You need referrals to see specialists or to get lab tests. |
| Pre-approval | You may be able to get many health services without pre-approval. | You will need pre-approval from your health plan before you can get any services. | You will need pre-approval from your health plan before you can get many health services. |
| Costs |
You may have a yearly deductible. You may also have deductibles for hospital care and prescription drugs. Care in the network costs a lot less than care outside the network. |
You are likely to have higher out-of-pocket expenses. You are less likely to have a yearly deductible. You usually pay a co-pay or flat fee for most services. |
You are less likely to have a yearly deductible. You usually pay a co-pay or flat fee for most services. |
