Elizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Written By Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Insurance Writer Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
| Deputy Editor, Insurance
Updated: Feb 15, 2024, 5:37am
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A comprehensive health insurance plan is beneficial regardless of your overall health and medical history. Health insurance helps pay for routine care, like an annual checkup, as well as emergency procedures, hospitalization, prescription medications and other forms of care that can be expensive when paid out-of-pocket.
Choosing the right health insurance plan for your needs is often easier said than done. There are multiple types of health insurance available, including an exclusive provider organization (EPO) plan.
An EPO plan is a type of health insurance that helps pay for medical care, but only if it’s from doctors and hospitals within the plan’s network.
When you get medical treatment in-network, the insurance company pays for a portion of the bill, and you pay what’s left depending on your deductible, coinsurance and out-of-pocket max.
A deductible is the amount you pay for covered services before your health insurance plan starts to help pay for your care. Coinsurance is the percentage of covered health insurance costs you pay after you pay your deductible amount. Your out-of-pocket maximum is the most you pay for your health care for the year.
An EPO doesn’t pay for out-of-network care. If you receive services out-of-network, you’re responsible for covering the entire cost, except for emergency medical care.
An EPO is the second most common type of health plan in the Affordable Care Act (ACA) marketplace. EPO plans make up 31% of all plans selected in the ACA are EPOs, second only to health maintenance organization (HMO) plans, according to a Forbes Advisor analysis of ACA plans.
An EPO health plan allows you to get medical treatment from providers and facilities that contract with the health insurance company. Those providers and health care facilities are considered “in-network.” The insurance company agrees to pay these doctors a certain amount for medical treatments and services.
When you get in-network care, the health insurance company covers the biggest portion of the cost. You pay the remaining balance in the form of a deductible, copayments and coinsurance (depending on the plan). A copayment is a set amount you pay for doctor visits and prescriptions after you pay your deductible.
One of the benefits of EPO insurance is that you don’t need a referral to see specialists. However, you must choose a specialist in the EPO’s network for the insurer to cover the visit.
Another thing to know about EPO health insurance is that pre-authorization may be required before the insurance plan covers certain medical procedures and treatments. From the insurance company’s perspective, a pre-authorization limits unnecessary care.
An EPO plan costs an average of $436 a month for a 30-year-old. See more average below based on age, individuals, couples and families.
