20+ Difference Between EPO And PPO (Explained)

Choosing medical insurance and understanding the differences between insurance can be hectic. Therefore, conducting thorough research on which medical insurance is best for you becomes crucial. Two of the widely used medical insurances are EPO and PPO.

The significant difference between EPO and PPO is that the former offers only a limited service and is relatively cheaper. In contrast, the latter offers a wide range of healthcare facilities and is somewhat more expensive.

Comparison Between EPO And PPO

Parameter	EPO	PPO
Meaning	It is an acronym for Exclusive Provider Organization, a third-party organization concerned with providing healthcare insurance plans on a small network of services to the people of the USA.	It is an acronym that stands for Preferred Provider Organization. This third-party organization focuses on providing healthcare insurance plans on an extensive network of services to the people of the USA.
Network	This insurance plan’s network of healthcare facilities, which comprises various healthcare professionals, pharmacies, hospitals, etc., is very small. Therefore, people generally do not get many options to choose from under this plan.	This insurance plan’s network of healthcare facilities, which comprises healthcare professionals, pharmacies, hospitals, etc., is very wide. Therefore, people typically get many options to choose from under this plan.
Type of facilities	This insurance plan is known for providing only in-network services, which means people can choose healthcare facilities from the sources that are a part of this plan.	This insurance is associated with providing not only in-network services but also out-for-network services, which means if people want to choose such healthcare facilities that are not a part of this plan’s network, then they can do so by paying more with some coverage.
General Physician	A primary care physician may sometimes be required in this healthcare insurance plan. In some scenarios, the concerned organization can ask people to visit a specific PCP/GP. They would agree to provide further coverage if that particular doctor goes further in the patients’ favor.	In this healthcare insurance plan, the patients would not need to meet a primary care physician or general physician to contact a specialist doctor.
Cost	This insurance plan is associated with lower costs than PPO. This is so because this plan does not provide out-for-network services and has a narrow network of in-network services.	This insurance plan is associated with a higher cost than EPO. This is because this plan has a wide range of in-network and out-for-network services.
Paperwork	Since this plan does not provide out-for-network services, thus people in this plan do not have to fill out any additional paperwork.	Since this plan provides out-for-network services, people availing of those facilities would have to fill out additional paperwork, such as claim paperwork.
Flexibility	This plan is considered less flexible than PPO as it only gives fewer options for healthcare facilities in-network, nor does it give the option of out-of-network services. Along with that, in some cases, even a Primary Care Provider may also be required.	This plan is considered more flexible than EPO as it has various in-network plans. It also offers out-of-network services and completely eliminates the need for a Primary Care Provider.
Urgent care	This plan is generally not considered to fit for those individuals who require urgent care regularly. It is limited by this plan’s in-network and does not allow out-for-network services. At times, it might not be possible for a patient to access his services, such as hospitals being busy or not providing the care the patient needs, etc., leaving the patient no choice but to wait and keep his life in danger.	This plan is considered suitable for patients who require urgent care regularly as not only this plan’s in-network is very wide, but this plan also provides coverage for out-of-network services.
Advantages	Low costs, allowing patients to have direct access to its network, does not require a PCP (in most cases), and coverage for emergency visits are some of the significant advantages of this plan.	A wide in-network, coverage for out-of-network services, greater flexibility, and no need for a PCP are some of the significant advantages of this plan.
Disadvantages	A narrow network, no option for out-of-network services, and lower flexibility are some of the significant disadvantages of this plan.	High cost and payment of extra money when someone chooses an out-of-network service are the major disadvantages of this plan.

Major Differences Between EPO and PPO

What Exactly Is EPO?

It is a healthcare insurance plan that is an abbreviation for Exclusive Provider Organization. This healthcare plan is concerned with allowing people to opt for various healthcare professionals and hospitals that are a part of this plan’s healthcare network.

However, it should be noted that this plan’s network is relatively small. Therefore, this plan allows people to only opt for in-network and does not allow for out-of-network.

In addition, since this plan allows only in-network providers, thus people do not have to care about filling out claim paperwork.

Features Of EPO Insurance Plan

Key Differences EPO

It is an initial Exclusive Provider Organization that aims to provide public healthcare services through doctors, specialists, and hospital visits that come under their network.

As per healthcare.Gov, this healthcare insurance or plan covers services only when a person goes to doctors who are part of the insurance network.

One of the notable features of this healthcare plan that also acts as a significant distinction between this plan and PPO is that the network of doctors, specialists, and hospitals of this insurance is smaller than PPO’sPPO’s network.

Speaking of the cost that is associated with this plan, it is generally relatively lower than PPO.

People booked under this insurance plan can not opt for doctors, specialists, or hospitals that do not come into this plan’s network. It is also referred to as in-network.

What Exactly Is PPO?

It is a healthcare insurance plan that is an abbreviation for Preferred Provider Organization. This healthcare plan provides people with various healthcare facilities from multiple healthcare professionals, pharmacies, and hospitals that fall within this plan’s network.

It also lets them choose multiple healthcare facilities not belonging to this plan’s network. Thus, this plan provides in-network as well as out-of-network. However, in this plan, people must fill out claim paperwork when opting for out-of-network facilities.

Features Of PPO Insurance Plan

Key Differences PPO

It is an initial for Preferred Provider Organization which aims to provide healthcare services to the public through doctors, specialists, and hospital visits that come under and out of their network.

As per healthcare.gov, this healthcare plan creates a vast network of healthcare professionals by contacting and contracting various doctors and hospitals. A person gets to pay less if he gets in touch with a healthcare professional that belongs to the network, and it also gives the patients an option to contact healthcare professionals that are not a part of their network.

One of the significant advantages of this healthcare plan that gives it an edge over EPO is that its network of healthcare professionals is way more extensive than that of EPO’sEPO’s network.

The cost associated with this plan is relatively higher than the cost of EPO’s program. A larger network can be considered one of the reasons behind its high price.

The primary benefit of this plan is that it allows people to opt for healthcare professionals and hospitals that do not fall within their network or the out-of-network.

The Contrast Between EPO And PPO:

Meaning

EPO – It is an initial for an Exclusive Provider Organization. It can be best described as a third-party organization that is concerned with providing the people of the United States of America (USA) with healthcare insurance plans on a minimal network.

PPO – It is an initial for Preferred Provider Organization. It can be best described as a third-party organization that is concerned with providing the people of the United States of America (USA) with healthcare insurance plans on a very wide network.

Network

EPO – The significant distinction between this healthcare plan and PPO is that this healthcare plan is concerned with a very limited or smaller network of healthcare services in the form of healthcare professionals, pharmacies, hospitals, etc., for people to choose from. People signing up for this healthcare insurance plan do not get many options to make a choice.

PPO – The notable feature and the significant advantage of this insurance plan is that this healthcare plan is associated with a more excellent network of healthcare services in the form of healthcare professionals, pharmacies, hospitals, etc., for people to choose from. People who have signed up for this insurance plan get a lot of options to choose from.

Type of facilities

EPO – This insurance plan is associated with offering only in-network services to the people meaning people who are a part of this healthcare plan only get to take healthcare services from resources that are a part of this healthcare plan.

Else, they would not get any form of coverage. So the availability of only in-network services is one of the significant disadvantages of this insurance plan.

PPO – This insurance plan offers both in-network and out-of-network services. This insurance plan’s network is already very wide.

On top of it, it also offers people out-of-network services meaning that they can choose to avail of healthcare services from such resources that are not a part of their network and still get some form of coverage. This proves to be a very significant advantage of this healthcare plan.

General Physician

EPO – Although not in every case, in some cases, a primary care physician may be required in this healthcare insurance plan. In some scenarios, the concerned organization can ask people to visit a certain PCP/GP, and they would agree to provide further coverage if that particular doctor goes further in the patients’ favor.

PPO – Unlike EPO, in this healthcare insurance plan, the patients would not need to meet a primary care physician or general physician to contact a specialist doctor. Thus, this insurance plan provides greater flexibility when choosing a doctor.

Cost

EPO – The cost of this healthcare plan is cheaper than that of a PPO’sPPO’s healthcare plan. The reason behind this is that this insurance plan does not provide out-of-network healthcare services, and also, its network is very limited and does not have many options for people to choose from.

PPO – The cost of this healthcare plan is more expensive than the cost of EPO’sEPO’s healthcare plan. The main reason behind this high cost is that this insurance plan provides not only in-network service but also aims to provide out-of-network services. Along with that, its network is very wide and leaves people with many options to choose from.

Paperwork

EPO – Since this insurance plan does not provide for out-of-network healthcare facilities, thus people do not have to care about filling out any form of additional paperwork, such as claim paperwork.

PPO – Since this insurance plan provides out-of-network healthcare facilities. Thus, people in this insurance plan might have to fill out additional paperwork, like claim paperwork, whenever they choose out-of-network services.

Flexibility

EPO – In comparison with PPO, this insurance plan is associated with providing less flexibility. This is because people in this healthcare plan neither have many choices for in-network services nor can opt for out-of-network services. Along with that, in some cases, a primary care provider may also be required.

PPO – Compared with EPO, this insurance plan provides greater flexibility as its wide network allows people to opt for out-of-network services. In addition to that, it does not even require primary care providers to get ahead with specialist doctors.

Urgent care

EPO – This insurance plan is not the first choice for individuals with urgent care treatments, such as dialysis. This is because a person might not be able to get a service when he really needs it as this plan’s network is small and does not allow out-for-network services.

Thus, a person would have no choice but wait and put himself in danger if he happens to have a condition that demands urgent care.

PPO – One of the other areas where this insurance plan has the edge over EPO is that it is considered best for individuals who suffer from conditions that demand urgent care, such as dialysis and insulin assistance.

Since this plan has a very wide network, a person needing urgent care would not have to worry about availing services as he can do so by going to any place that comes under this plan. Moreover, if that is also unavailable, he can always opt for out-for-network services and still get some coverage instead of waiting and putting himself in danger.

Advantages

EPO – The significant advantages of this healthcare insurance plan are that it is relatively cheaper, allows people to directly choose from any healthcare service that comes into their network, does not require primary care providers (in most cases), and provides coverage for emergency visits.

PPO – The significant advantage of this healthcare insurance plan is that this healthcare plan has a very wide network of healthcare facilities and gives people many options.

Along with that, it also allows people to choose out-of-network services and provides greater flexibility. It also allows people to proceed with their treatment plan without choosing a primary care provider.

Disadvantages

EPO – The major disadvantage associated with this healthcare plan is that it has a wider network and does not provide out-of-network services. Also, in some cases, primary care providers may need to get in touch.

PPO – The major disadvantage of this healthcare plan is that it can be considered pretty costly for some individuals, and not to forget, people have to pay more if they choose healthcare services from out-of-network.

Conclusion

EPO and PPO are two of the widely popular third-party organizations that focus on providing healthcare facilities to the people of the United States of America (USA).

The major difference between EPO and PPO is that the former has a very small network and does not provide out-for-network services, while the latter has a very large network and provides out-of-network services.

Frequently Asked Questions (FAQs)

Q1. What is meant by out-for-network services?

Out-for-network services do not come in the network of an insurance plan, but they do provide for such services. PPO insurance plan is one such example of providing such services.

Q2. How does PPO have greater flexibility?

PPO is concerned with greater flexibility under this insurance plan. One gets a wide range of in-network services, also can choose from out-for-network services, and does not need PCP to get in touch with specialists.

Q3. What are the major disadvantages of a PPO plan?

High cost and less coverage in the case of out-for-network services are the major disadvantages of this healthcare insurance plan.

Q4. What are the major disadvantages of the EPO plan?

A less wide network and no option for choosing out-for-network services are the major disadvantages of this healthcare plan.

Q5. What are the significant differences between EPO and PPO insurance plans?

The former is associated with a smaller network of healthcare facilities, has no option of out-for-network services, and has less flexibility than the latter, which has a wider network of healthcare facilities, has the option of choosing out-for-network services, and has greater flexibility.