An Exclusive Provider Organization (EPO) plan requires you to only visit health facilities and see medical providers that are in your plan’s network. If you visit an out-of-network provider, your EPO will not cover the services unless it is a medical emergency. An EPO plan might be a good option if you want low monthly fees.
It is also good if you are okay with only see the in-network physicians, do not need frequent medical attention and do not want to ask your PCP for a referral.
EPOs give you more freedom than HMOs. For example, you will not need a referral from your primary care provider (PCP) to see an in-network specialist. But you have less freedom than a PPO since you must have a PCP.
EPOs have lower premiums than HMOs and PPOs. You will have a deductible for in-network fees.
If you go to out-of-network professionals and facilities, you will be responsible for all of the fees unless it is a medical emergency. Your EPO cannot charge you more than an in-network fee for emergency services at an out-of-network facility.
Since there is a deductible on services from in-network providers and no coverage for out-of-network professionals, you may combine your EPO plan with a Health Savings Account.
You may be able to take advantage of EPO benefits of low monthly premiums and specialist autonomy with a separate account for medical expenses.
A Health Savings Account is not a supplemental insurance plan, but it can save you money through tax-deferred contributions and tax-free withdrawals for medical fees.