Knowing how an HMO, PPO, and EPO differ in flexibility, cost, and network restrictions will help you choose the right plan for your needs. An HMO is more generally restrictive, requiring that you must designate a primary care physician who coordinates all your care and refers you for care from specialists within their network of providers. This type of structure generally has lower out-of-pocket costs and premiums, although it limits your ability to see providers who are not in the network with very few exceptions.
A PPO offers some flexibility in that you are able to visit any healthcare provider without a referral, including providers outside the network; however, you will pay more for this flexibility both in terms of premium cost and out-of-pocket for care received outside the network. An EPO then combines elements from HMO and PPO plans. Much like an HMO, it limits coverage to in-network providers. Like a PPO, it does not require referral to see any specialists. At the very same time, however, it does not cover out-of-network care except in emergencies.
Consider how often you need to see a doctor, whether it is important to you to have your own providers, and how much you have the disposition to pay for premium versus out-of-pocket costs. If you want to pay more reasonable premiums and do not have any problem staying in the network, this may make an HMO best for you. If flexibility is key and one can afford to pay more, then a PPO would be more fitting. One might get an ideal medium with an EPO if one wants some flexibility but at reduced costs compared to a PPO.
