Knowing what your network does for you can be confusing. Three of the main network options are PPO, preferred provider organization, HMO, health maintenance organization, and EPO, exclusive provider organization. One of the main differences is the availability you have to doctors in each one. When you have a PPO, you have the choice to see any doctor you want and you can usually even see out of network doctors, you’ll just expect to pay a little more. The advantage of a PPO is that you have more choices. If you are changing plans and already have established doctors, getting a PPO will typically allow you to keep your doctors.
When you choose an HMO, you are assigned a doctor and need to get referrals to see specialists. Unlike a PPO, you don’t have out of network benefits. So if you want to see someone that doesn’t take you plan, you are paying the full out of pocket expense for your appointment or treatment. If you do have a close network of doctors that all work out of the same facility or hospital, then an HMO might work, for instance, Scott and White has plans in Texas that are HMOs and use the Baylor hospital systems. Healtcare.gov has several HMO’s to choose from including Blue Cross Blue Shield, Scott and White and Molina.
EPOs are very small networks. Even though you don’t have to have a referral to see specialists, you do have a very small network of doctors to choose from and no out of network benefits. Of all of the networks, these are typically the smallest. Available options in TX for EPOs include, Ambetter and Oscar.
Out of all 3, PPOs will give you the most flexibility with your medical care. As someone who doesn’t have access to group health, you may not think you can get a PPO plan, but there is access to them if you talk to the right agent.