All you need to know about an Exclusive Provider Organization (EPO)

An exclusive Provider Organization is a type of health insurance plan that gives you exclusive access to medical care within the plan`s network. The insurance company for an Epo plan has a vast network of hospitals, doctors, and other health care providers. This plan does not cover treatments received outside the network by the policyholder, with the exception of emergencies.

Features of EPO plans

The basic features of EPO plans include:
  • The insurance plan doesn’t pay for out-of-network costs.
  • You need to request authorization before you visit an out-of-network hospital.
  • You don`t need a referral to gain access to specialist visits covered by the insurance provider.
  • Selection of a primary healthcare provider is required.

Cost of an EPO Plan

There is no fixed cost for an EPO plan instead, the cost is solely based on the terms and conditions of the plan and your location. Note: it is important that you check if the deductibles, out-of-pocket limits, and coinsurance are favorable before purchasing an EPO plan.

Pros of an Epo Plan

  • vast networks: it allows you to choose any provider of choice within the plan`s network.
  • Low monthly premiums: EPO plans have reduced premium costs,
  • Plans available with no referrals: It requires no referrals to settle bills with hospitals and visit specialists

Con of an Epo Plan

  • High deductibles: You might be required to pay more annual deductibles in exchange for reduced premium cost
  • No coverage outside of the plan`s network: This plan does not cover the costs of treatments received out of the plan`s network. So, you need to ensure that you go to hospitals within the network.

Crucial Things to Know About Epo Plans Before Investing in Them

Here are things you need to fully understand before investing in a health insurance plan;
  • You are required to pay monthly premiums for the maintenance of the insurance plan.
  • You need to pay a certain amount as a deductible till the time the EPO plan begins covering the costs.
  • You are required to pay coinsurance or copayment after the completion of the payment of deductibles.

Why Choose an Epo Plan?

If you can commit to using a particular network of healthcare providers, an EPO could be a suitable option for your health insurance. Moreover, selecting an EPO might be preferable if having a primary care physician is not a crucial requirement for you.


EPO plans may be a good choice if you are willing to use network providers and do not need the flexibility to see out-of-network doctors.

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