What is Aetna EPO?
Asked by: Cassie Orn | Last update: August 29, 2022Score: 4.1/5 (54 votes)
An Exclusive Provider Organization (EPO) is a lesser-known plan type. Like HMOs, EPOs cover only in-network care, but networks are generally larger than for HMOs. They may or may not require referrals from a primary care physician. Premiums are higher than HMOs, but lower than PPOs.
What is the difference between a PPO & EPO?
A PPO offers more flexibility with limited coverage or reimbursement for out-of-network providers. An EPO is more restrictive, with less coverage or reimbursement for out-of-network providers. For budget-friendly members, the cost of an EPO is typically lower than a PPO.
What does EPO stand for Aetna?
With Aetna's Exclusive Provider Organization (EPO) plans, you can give your employees an easy way to get care, while saving on benefits costs with an exclusive network.
Is an EPO worse than a PPO?
An EPO is usually more pocket-friendly than a PPO plan. However, if you choose to get care outside of your plan's network, it usually will not be covered (except in an emergency).
What does EPO plan mean?
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).
PPO vs EPO: What's the Difference?
Is an EPO better than an HMO?
EPO health insurance often has lower premiums than HMOs. However, HMOs have a bigger network of healthcare providers which more than makes up for it. You may also want to consider your location when choosing a health insurance plan. EPOs are better suited for rural areas than HMOs.
What is an EPO plan vs HMO?
An Exclusive Provider Organization (EPO) is a lesser-known plan type. Like HMOs, EPOs cover only in-network care, but networks are generally larger than for HMOs. They may or may not require referrals from a primary care physician. Premiums are higher than HMOs, but lower than PPOs.
What are the pros and cons of an EPO?
Pros and Cons of an EPO
Low monthly premiums: EPOs tend to have lower premiums than Preferred Provider Organizations (PPOs), though they're higher than Health Maintenance Organization (HMO) premiums. Large networks: They generally offer a wider selection of care providers than HMOs.
Why is EPO more expensive than PPO?
The cost of a PPO plan will also increase the more often you take advantage of that freedom, as you are expected to cover a higher proportion of the costs incurred in seeing healthcare providers from outside the network. EPOs are usually cheaper due to the restrictions on which healthcare providers you can visit.
How does an exclusive provider organization work?
An exclusive provider organization, or EPO, is a health insurance plan that only allows you to get health care services from doctors, hospitals, and other care providers who are within your network. Your insurance will not cover any costs you get from going to someone outside of that network.
Do doctors prefer HMO or PPO?
PPOs Usually Win on Choice and Flexibility
If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.
Is it better to do HSA or PPO?
While the option of opening an HSA is attractive to many people, choosing a PPO plan may be the best option if you have significant medical expenses. Not facing high deductible payments makes it easier to receive the medical treatment you need, and your healthcare costs are more predictable.
What is the downside of an EPO?
What are the Cons of EPOs? You may not be able to continue with your current doctor or specialists. You must use in-network providers unless it's an emergency. For EPOs with local networks only, non-emergency medical needs will not be covered when you travel.
What is the benefit of an EPO?
Lower Rates
As EPO contracts are exclusively with specific doctors and hospitals in a network, rates are lower compared to other plans like PPOs. Lower costs are achieved by negotiating favorable reimbursement rates with in-network healthcare providers which results in lower monthly premium payments.
Are EPOs good?
Overall, the combination of its low premiums and low cost-sharing make EPOs a good choice for many people. If you are finding it mind-boggling as you compare different plans, check out our comparison of HMOs, PPOs, EPOs.
Does EPO have out of network benefits?
With an EPO, you can use the doctors and hospitals within the EPO's network. However, you cannot go outside the network for covered care. If you do go out-of-network, your EPO will not pay for any services. The only exception is if you have an emergency or urgent care situation.
Is deductible same as out-of-pocket?
Essentially, a deductible is the cost a policyholder pays on health care before the insurance plan starts covering any expenses, whereas an out-of-pocket maximum is the amount a policyholder must spend on eligible healthcare expenses through copays, coinsurance, or deductibles before the insurance starts covering all ...
Are high deductible plans worth it?
The pros of high-deductible health plans
An out-of-pocket maximum is the most you'll have to pay during your coverage year. If you're relatively healthy and generally don't have medical expenses beyond annual physicals and screenings, you're more likely to save money by opting for an HDHP over a low-deductible plan.
Why do doctors not like HMO?
Since HMOs only contract with a certain number of doctors and hospitals in any one particular area, and insurers won't pay for healthcare received at out-of-network providers, the biggest disadvantages of HMOs are fewer choices and potentially, higher costs.
Why would a person choose a PPO over an HMO?
A PPO plan can be a better choice compared with an HMO if you need flexibility in which health care providers you see. More flexibility to use providers both in-network and out-of-network. You can usually visit specialists without a referral, including out-of-network specialists.
Why is HMO more expensive than PPO?
PPOs have larger networks of providers
Both HMOs and PPOs have a network of doctors, hospitals, and other healthcare providers. Your out-of-pocket costs are less when you use medical providers in this network. HMOs typically require you to choose a primary care provider from the network directory.
Does EPO plan require authorization?
Ans: EPO providers have a pre-authorisation requirement for expensive treatments and medications to keep costs low and ensure that their plans cover only necessary things. CT scans, MRI scans, expensive surgeries, prescription drugs and hospitalisations are some things that require pre-authorisation.
Why is EPO banned?
Why is EPO prohibited? EPO has a long history of abuse in endurance sports. Blood doping involves the misuse of certain techniques and/or substances like EPO to increase one's red blood cell mass, which allows the body to transport more oxygen to muscles and therefore increase stamina and performance.
Why do athletes use EPO?
EPO stimulates the production of red blood cells in bone marrow and regulates the concentration of red blood cells and haemoglobin in the blood. This is useful for athletes, since red blood cells shuttle oxygen to the cells, including muscle cells, enabling them to operate more effectively.