EPO vs. PPO Insurance: Understanding the Key Differences

Employer Payment Organization (EPO)

* Similar to an HMO

* Members must get care within a specific network of providers

* Out of network care may be provided at a reduced cost

* Members cannot self refer to see a specialist

* EPOs offer fixed copayments and deductibles

Preferred Provider Organization (PPO)

* Members can go in and out of network

* In-network care does not require a referral

* Members can self-refer to see a specialist

* PPOs offer negotiated rates with providers and members may be responsible for a percentage of the bill, including deductibles and copays