Difference Between HMO and EPO
HMO vs EPO
HMO and EPO are both health insurance schemes. HMO stands for Health Maintenance Organization, and EPO stands for Exclusive Provider Organization. Well, there are several technical differences between HMO and EPO.
When considering their difference, the HMO can be termed as an insured product, which means that the insurance company will pay the costs of the claim. On the other hand, the EPO can be termed as a self-insured product, where the employer has to pay the costs.
In terms of flexibility, the Exclusive Provider Organization is more flexible than the Health Maintenance Organization. In the case of Health Maintenance Organization insurance, a referral from the Primary Care Physician is required. It is the PCP who manages all the medical servicesand provides referrals. On the contrary, for Exclusive Provider Organization insurance, there is no need for a referral from a Primary Care Physician.
An HMO also requires that the insured person stay within the network of the providers. This is the same with EPO insurance, therefore, there is no out of network coverage for both insurance schemes.
An HMO plan generally has a vast network of doctors, whereas the EPO has only a limited network of doctors.
When comparing the premiums, the EPO has a lower premium than the HMO. The HMO is determined on a capitated basis, whereas the EPO is based on the services provided. When considering their coverage, the EPO is better suited for the rural areas.
The Health Maintenance Organization is regulated under the HMO laws and regulations. The Employee Retirement Income Security Act regulates the Exclusive Provider Organization.
Summary:
1. The Exclusive Provider Organization is more flexible than the Health Maintenance Organization.
2. In the case of Health Maintenance Organisation insurance, a referral from the Primary Care Physician is required. A referral from a Primary Care Physician is not needed for EPO insurance.
3. HMO can be termed as an insured product, which means that the insurance company will pay the costs of the claim. EPO can be termed as a self-insured product, where the employer has to pay the costs.
4. When comparing the premiums, the EPO has a lower premium than the HMO.
5. The Health Maintenance Organization plan generally has a vast network of doctors, whereas the Exclusive Provider Organization has only a limited network of doctors.
6. Unlike the HMO, the EPO is better suited for the rural areas.
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I really don’t know much about HMO i just know is its a networks of doctors, hospitals, health care providers, and pharmacies that offer medical behavior at a cheap cost to members
i would like to know more about it……?
Your information regarding HMOs requiring a referral from a primary care provider is not necessarily correct. I have been covered by an HMO (thru my employer) for many years, and there has never been a referral required to see other providers/specialists.