Affordable Care Act

Exclusive Provider Organization (EPO) Plans

Updated on November 14, 2019


An Exclusive Provider Organization (EPO) health insurance plan requires you to use the doctors and hospitals within its own network, much like a Health Maintenance Organization (HMO). As an EPO member, you cannot go outside your plan’s network for care. Also note that there are no out-of-network benefits under an EPO health insurance plan.

Cost and benefits of EPO health insurance plans

EPO health insurance plans typically cost you less than Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans with lower rates for care.

The downside of this type of plan is that any provider outside of the EPO network isn’t covered by your insurance. But because of these limitations, EPO plans generally can be suited well to individuals who don’t anticipate needing a great deal of medical care and want to save money.

An upside to the EPO health insurance plan is that you usually don’t have to get referrals to see specialists, which makes the process a lot faster if you know what you need, and don’t want to go through a primary care provider to get it.

eHealth’s 2016 analysis shows that the amount of qualifying health plans available to consumers has been slowly decreasing, but having variations in plans, such as EPO plan options might open up ways to save when shopping for health insurance.

To help find the right health plan for you, enter your zip code where requested on this page to see a quote.

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