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How to Choose Between an HMO, PPO, and EPO Health Plan

Open enrollment during this time of year means selecting a health plan. What's the difference between an HMO, EPO, and PPO? How can you tell what is the best option for you and your family?

By
Sanaz Majd, MD,
Episode #225

4 Tips to Help You Choose a Health Plan:

1. As the very first step, estimate how often you will need office visits, labs, imaging, etc. If you have chronic health conditions, like diabetes or COPD, that require more frequent visits and services, then a plan with a lower copay, but perhaps with a higher monthly premium, may be more optimal. If you are healthy and see the doctor perhaps only once or twice a year, it may be more prudent to select a plan with higher copays but lower monthly premiums.

2. Review your med list and the corresponding copays for each and compare it to the various formularies of the plan options. This one small step can save you a lot of money. Because health plans have their own "formularies," or preferred medications. Therefore, comparing and contrasting cost of each of your medications, especially if you are on a brand rather than a generic drug, can be essential for your wallet.

3. If you have a specialist you particularly like, research if they accept the plans that are available to you. This may be a deal breaker for some.

4. You can always forgo your employer’s plan and opt for an affordable care act plan instead. I am always surprised to hear that patients are not aware of this choice. Sometimes Obamacare is less costly. Go to your state’s  corresponding affordable care act web site to compare—they often give you quotes after a few simple questions.

If you have a specialist you particularly like, research if they accept the plans that available to you. 

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

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