What’s the Difference Between PPO and EPO Health Insurance?

In the CoveredCA plan options you may have noticed that Blue Shield is offering an EPO plan that looks similar in coverage to Anthem Blue Cross’ PPO plan, but is less expensive. So what’s the difference? Simply put if you see a physician in Anthem or Blue Shield’s networks, the plans will function similarly. If you see someone outside the network then there is a huge difference.

PPO means Preferred Provider Organization. Most health insurance plans are PPO’s, which means your plan functions normally if you see a physician in the network. If you see someone outside of the network they’ll typically still provide coverage, but your deductible and out of pocket max will be doubled or tripled. Basically, the insurance company will still pitch in for many out of network doctors, but you’ll end up paying a larger portion.

EPO means Exclusive Provider Organization. If you see a physician in network, your plan functions normally. If you see someone outside the network there is no coverage at all. That can be an issue if you need to see a specialist and there aren’t any in network near you.
You’ll typically save money on your monthly premium going with an EPO, but it comes at the expense of a more restrictive network of doctors you can see.


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