HMO – PPO – EPO: What’s The Difference?

HMO - Health Maintenance Organization
An HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. You will usually need a referral from your Primary Care Physician to see a Specialist, resulting in multiple co-pays. All healthcare services are managed in-network through your Primary Care Physician.​

​In California, the popular HMOs are Kaiser Permanente, Sutter Health Plus, Western Health Advantage, Health Net of California, Sharp Health Plan, LA Care, Molina Healthcare, and Valley Health Plan.

You will usually need a referral from your Primary Care Physician to see a Specialist, resulting in multiple co-pays.

PPO - Preferred Provider Organization
A PPO is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. PPOs do not require you to select a Primary Care Physician. One of the benefits of a PPO is you usually can self-refer to a Specialist.
 
In California, the popular PPOs are Blue Shield of California, Health Net Life Insurance Company, and Oscar.

One of the benefits of a PPO is you usually can self-refer to a Specialist.

EPO - Exclusive Provider Organization
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). Under an EPO plan you do not choose a Primary Care Physician. You can receive care from any of the in-network doctors and self-refer to in-network specialists.
 
In California, the popular EPOs are Anthem Blue Cross, Health Net Life Insurance Company, and Oscar.

You can receive care from any of the in-network doctors and self-refer to in-network specialists.

If you want to discuss options about your health insurance, we recommend speaking with an independent insurance agent like George Beach Insurance Services. We work for you the client, and not a particular big company.

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