What is an EPO Health Plan?

by Lisa Russell ; Updated October 25, 2017

Exclusive Provider Organizations (EPOs) are just one of the many different types of agreements between medical insurance companies and health care providers. Learn about EPOs and how they differ from health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

Features

EPOs will only cover your medical expenses if the provider you see is part of the network.

Benefits

EPO health plans are often cheaper than PPOs or HMOs. With a good selection of specialists and adequate emergency care options, this can be a great way to save money on health insurance.

Considerations

Examine the network of physicians before agreeing to an EPO. Make sure they offer specialists that you need. Make sure the emergency care options are reasonable, and close to your home. A large company that offers an EPO may have a large network of physicians near its main office and fewer to serve the outlying areas.

Geography

EPOs aren't legal in every state. In the United States, they are not recognized by federal law. They are available only in states who haven't specifically disallowed them or have made regulations to allow them. California was the first state to recognize Exclusive Provider Organizations.

Warning

Always understand your policy. Seeking medical care, even in an emergency, from a clinic or physician outside of the EPO network can make you personally liable for the expense. EPOs typically do not cover even emergency treatment outside the network. If you're traveling or if your EPO emergency provisions aren't adequate, you could end up in debt.

About the Author

Lisa Russell has been a writer since 1998. She's been published in Rethinking Everything Magazine, Playdate, AERO and Home Educator's Family Times. She has a Bachelor of Science in business marketing management and a professional background in marketing, education, cosmetology and hospitality.