Which health insurance plan is right for you?
Selecting the right health plan for you and your family is a big decision, especially since there are so many different types of plans.
Having a clear understanding of the fundamental differences between Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans can help guide you to the right decision. So what should you consider before making a decision?
Overview and comparison
Health Maintenance Organization (HMO) | Preferred Provider Organization (PPO) | Exclusive Provider Organization (EPO) | |
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Access to an extensive network of doctors, hospitals and other healthcare providers |
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Ability to see the doctor or specialist you want without a PCP to authorize treatment |
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Coordination of care |
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Out-of-network coverage |
You cover the full cost (except in an emergency) |
You will receive some coverage for out-of-network visits |
You cover the full cost (except in an emergency) |
Cost of plan |
Lower monthly premiums |
Higher premiums, but more flexibility in choice of providers |
Lower monthly premiums |
Finding the plan that fits best: Price vs flexibility
Choosing the right plan ultimately depends on what will work best for you and your family.
A PPO may be better if you already have a doctor or medical team that you want to keep. An HMO might make sense if you don’t mind having a PCP manage your care. An EPO is a nice compromise between both a PPO and an HMO plan, but the decision still comes down to the amount of flexibility you and your family will need.
If you have a doctor or specialist you like, you can determine if they are in-network by using the MyCare Finder tool.
We're here to help
Have questions or need more information about our individual and family plans? Call 800.451.1181 for assistance.
You can also walk-in or schedule an appointment at one our Capital Blue Cross Connect health and wellness centers.