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Let’s Break Down HMO, PPO & EPO

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January 19, 2015
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There are a lot of abbreviations out there for health insurance.  A lot of them!  It’s really important to understand the coverage that you’re purchasing, which is why using an agent is a good idea.  Here are a couple of common abbreviations that it might be helpful to familiarize yourself with prior to your appointment.

  • HMO – Health Maintenance Organization – an HMO is a network of providers typically put together by the insurance carrier.  Your Primary Care Doctor is usually responsible for coordinating your care and oftentimes a referral is required to see a specialist.  An HMO will usually not provide out-of-network coverage except for an emergency.
  • POS – Point of Service – a POS plan is similar to an HMO except that there is coverage out of network.
  • PPO – Preferred Provider Organization – a PPO is the form of insurance that is most familiar.  There is a network of providers and coverage for out-of-network providers as well.  Typically, referrals are not required for a specialist.
  • EPO – Exclusive Provider Organization – an EPO is a blend of an HMO and a PPO.  There is typically no referral required to see a specialist.  An EPO will usually not provide out-of-network coverage except for an emergency.
  • ACO – Accountable Care Organization – an ACO is a partnership between a healthcare system and an insurance company.  The insurer and provider system agree to share the risk together to provide care for the insured individuals.  An ACO is designed to deliver coordinated care to cost-effectively manage healthcare costs for insured individuals.  An ACO will usually not provide out-of-network coverage except for an emergency.  In addition, an ACO may have out-of-network coverage if the care required is not able to be provided within the sponsoring health system.

This list doesn’t cover every abbreviation out there – it is not meant to be exhaustive.  Keep in mind, each policy is unique, this post isn’t specific advice for you but rather a general overview of common terms and their common meanings.  Talk with your agent about your specific coverage.  Or better yet, let an agent at Webb Insurance help you out.  Contact us here or 800-303-6329.