What is an EPO, and is it right for you?

Understanding health insurance can be daunting, especially when it comes to understanding different plan types. One type of plan that is often overlooked is the Exclusive Provider Organization (EPO). Here’s an overview of what an EPO is and how it works.

What is an Exclusive Provider Organization (EPO)?

An EPO (or Exclusive Provider Organization) plan offers in-network coverage only and does not require referrals for specialty care. EPO members may be required to select a PCP and should refer to their summary of benefits and coverage. Also, EPO plans don’t cover out-of-network care unless it’s an emergency.

Save money with an EPO plan with an HSA. Some EPO plans are available with Health Savings Accounts (HSAs). An HSA can help members save money. The money members put in their HSAs is tax deductible, and withdrawals are tax-free when used to pay for qualified medical expenses. The HSA account balance rolls over from year to year, and the money in the account belongs to the member.

Learn more about HSAs

Advantages of an EPO

  • In-network coverage
  • No referrals
  • Out-of-network coverage for emergencies
  • Health Savings Account options

Is an EPO the right health insurance plan for you?

Here are some things to consider when deciding if an EPO is right for you:

  • If you are interested in saving money on health care costs, an EPO insurance plan with a health savings account (HSA) may be the best option for you.
  • If you prefer the flexibility to choose in-network and out-of-network providers, a Preferred Provider Organization (PPO) plan may be the better option.
  • If you see the doctor often or would like your primary care physician to coordinate your care with referrals, an HMO plan may be a better option for you.

Essential health benefits

All AmeriHealth New Jersey health plans include the following ten essential health benefits:

  1. Preventive, wellness, and disease management services
  2. Emergency care
  3. Ambulatory services
  4. Hospitalization
  5. Maternity and newborn services
  6. Pediatric services, including dental and vision
  7. Prescription drugs
  8. Laboratory services
  9. Mental health and substance use disorder services, including behavioral health treatment
  10. Rehabilitation and habilitation services

Get the AmeriHealth New Jersey Advantage!

You can rest assured with the knowledge that no matter which AmeriHealth New Jersey plan you choose, you’ll have access to high-quality care.

Learn more about all your plan options