What is an EPO (Exclusive Provider Organization)?

An EPO (Exclusive Provider Organization) is a hybrid between HMO and PPO. Like an HMO, it requires using in-network providers and does not cover out-of-network care (except emergencies). Like a PPO, it typically does not require a primary care physician or referrals for specialists. EPOs tend to have lower premiums than PPOs (because the insurer does not pay for out-of-network care) but higher than HMOs (because of less aggressive management). They appeal to people willing to stay in-network but who want to skip the referral requirements. Knowing whether a plan is HMO, PPO, or EPO is important when comparing coverage; out-of-network exposure differs significantly. POS (Point of Service) plans are another hybrid combining HMO and PPO features.