What is an EPO health insurance plan?

Everything you need to know about EPO health insurance plans.

What you need to know

An exclusive provider organization, or EPO, is a health insurance plan that is often described as a hybrid between HMOs and PPOs.

Like an HMO, EPO plans do not cover out-of-network health care providers. You will not be reimbursed for health care services you get at an out-of-network provider.

Like a PPO, EPO plans do not require that you get a referral from your primary care physician in order to see a specialist. You can make appointments directly with a specialist without having to see your primary care physician first.

EPOs combine the flexibility of PPOs with some of the stricter rules of HMOs at a price point that typically lands between the two types of plans. If you want more freedom to make appointments directly with specialists, but don't mind staying within your network of providers, EPOs are a good choice for you.

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