What does Anthem Blue Cross EPO mean?
Asked by: Sebastian Larkin | Last update: January 2, 2026Score: 4.5/5 (70 votes)
What is Anthem Blue Cross EPO?
What Is An EPO (Exclusive Provider Organization) Plan? An EPO is a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are usually less expensive than a PPO. Like a PPO, you won't need a referral to get care from a specialist.
Is it better to get EPO or PPO?
The EPO plan itself costs about the same in terms of premiums, however the coverage is significantly better. The deductible is lower, the out of pocket max is half that of the PPO, the copays are much lower for both PCP and Specialists, and the co-insurance is better.
What does EPO mean on an insurance plan?
Exclusive Provider Organization (EPO) Plan. A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency).
Does Blue Cross Blue Shield EPO require referrals?
With an EPO, members have only in-network coverage (except for emergencies), but they do not need to select a primary care physician (PCP) or get referrals to see specialists. To go directly to Independence's EPO plans, visit: Personal Choice EPO plans. Personal Choice EPO Reserve plan (EPO plus HSA)
🔥 Anthem Blue Cross EPO Review: Pros and Cons
What are the disadvantages of EPO health insurance?
A disadvantage of EPOs is that members that must see an out-of-network provider have to pay all costs for these services with no reimbursement.
Does EPO have copay?
Except for preventive care, you pay a copay for each network office visit (in-person or virtual): $40 for primary and behavioral health care visits, $60 for visits to a specialist or when seeking care at an urgent care center, and $10 when using the telemedicine benefit.
Which is better, EPO or HMO?
EPO plans offer a larger network than an HMO plan but typically do not have the out-of-network benefits of PPO plans. EPO plans do not require you to select a primary care physician (PCP) giving you a broader network of providers.
Do doctors prefer HMO or PPO?
HMO plans might involve more bureaucracy and can limit doctors' ability to practice medicine as they see fit due to stricter guidelines on treatment protocols. So just as with patients, providers who prefer a greater degree of flexibility tend to prefer PPO plans.
What is EPO in medical terms?
Erythropoietin (EPO) helps your body maintain a healthy amount of red blood cells (erythrocytes). There's also a synthetic (man-made) form of erythropoietin that healthcare providers use to treat anemia that results from chronic kidney disease.
Who is an EPO best for?
EPO health insurance may be a good fit for someone who enjoys the freedom of choosing their providers without referrals, while being comfortable staying within the EPO network.
What does 20% coinsurance mean?
For example, if your health insurance plan's allowed amount for an office visit is $100 and your. coinsurance is 20%: • If you've paid your deductible: you pay 20% of $100, or $20. The insurance company pays the rest.
What is the difference between a deductible and an out-of-pocket?
A deductible is the cost a you pay on health care before the health plan starts covering any expenses, whereas an out-of-pocket maximum is the amount a you must spend on eligible healthcare expenses through copays, coinsurance, or deductibles before the health plan starts covering all covered expenses.
What insurance is better EPO or PPO?
EPO: Requires using in-network providers for non-emergency care, leading to lower premiums but no coverage for out-of-network services. Key Differences: PPOs are best for those needing flexibility and frequent specialist visits; EPOs are suitable for those with infrequent healthcare needs and lower costs.
What does Anthem PPO cover?
Plan Summary
The Anthem Blue Cross PPO provides worldwide coverage for hospitalization and surgical, medical, vision and prescription drug expenses.
What are the two most common health insurance plans?
Before choosing a health insurance policy for yourself, your family, or your employees, you must know what types are available. Some popular health insurance policy options are: Preferred provider organization (PPO) plans. Health maintenance organization (HMO) plans.
What is the downside to a PPO plan?
Cons of PPO Plans
Less Coordination: Without a primary care doctor managing your healthcare, there's less oversight, and it can be harder to keep track of your treatments and appointments.
Why are out of pocket costs higher with PPO?
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral.
Why do dentists prefer PPO over HMO?
Dental PPOs are the most common commercial dental plan types and offer more flexibility in dentist choice. Dental HMO plans charge lower premiums but limit coverage to in-network dentists for most procedures. Consider your needs, budget, and dentist preferences when choosing between HMO and PPO plans.
What are the disadvantages of an EPO?
However, the primary limitation of EPO plans is their strict in-network coverage policy; they do not cover services rendered by out-of-network providers except in emergencies. This can be restrictive if you live in an area with fewer in-network facilities or if you often need medical care while traveling.
What is the difference between Anthem, EPO, and PPO?
EPOs tend to be more affordable, but you'll usually get less coverage and more restrictions. PPOs are more flexible and provide greater coverage, but come with a higher out-of-pocket cost. *Out-of-network services generally available with higher out-of-pocket costs.
What does EPO mean in insurance?
An exclusive provider organization (EPO) falls somewhere between an HMO and PPO. It provides the same covered services and lower costs of an HMO along with a broad network and some of the flexibilities of a PPO.
Is EPO a good health plan?
EPO and PPO plans are both solid options that can help cover medical costs for you and your family. If you're looking for coverage that reaches beyond a limited network, then a PPO may be right for you. However, EPOs tend to be more affordable and offer sufficient coverage for in-network medical services.
How much does EPO cost?
The median total cost for EPO over 12 months was $4178.70 ($2416.37-5955.12) and for DA was $2302.92 ($1177.86-4218.93).
Is Obama Care PPO?
Under ObamaCare most plans are either HMOs or PPOs. Knowing which one is right for you, can make a big difference in regards to how you get your health care. Other plan types include the less common EPO Exclusive Provider Organization type or POS Point of Service plan type.