What do EPO, PPO and POS mean?

Personal Finance, Creating Healthy Communities July 15, 2013 Print Friendly and PDF

In the world of health insurance, there are separate and distinct types of insurance plans. In general, the three types of plans are Exclusive Provider (EPO) network, Preferred Provider (PPO) network, and Point of Service (POS) network. These plans differ by cost and types of coverage provided.

The Exclusive Provider network or EPO is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). This means that you cannot go to out-of-network doctors and have it covered by your insurance (except in an emergency) but the premium and deductibles are usually the lowest of the three plan types.

The Preferred Provider network or PPO is a plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that are part of the plan’s network but you still can use doctors, hospitals, and providers outside of the network, even in non-emergency situations for an additional cost. This plan usually has the greatest flexibility in choice of doctors.

The Point of Service network or POS is a plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network, and this plan may require you to get a referral from your primary care doctor in order to see a specialist.

Healthcare.gov provides a comprehensive glossary of terms. The University of Maryland Extension provides a hypothetical comparison between fictional EPO, PPO and POS plans as a teaching tool, but actual differences between plans and associated costs that you will compare will vary.

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This work is supported by the USDA National Institute of Food and Agriculture, New Technologies for Ag Extension project.