HMO vs EPO Plans ULTIMATE Guide ✅ Obamacare 2025

What's up everyone! Welcome back to a brand new video here at Cuspide Insurance. Open enrollment season is here and a lot of the questions people ask is which one should I choose between an HMO and an EPO. So this is your complete guide to HMO versus EPO plans. Which one is better? This is all going to be answered and real quick, the marketplace is open right now. If you want to renew your health insurance or apply for health insurance for 2025, call the number on the screen right here 305-970-8583. Contact our team here at Cuspide Insurance. Let's get into it. So diving straight in, what is an HMO plan? An HMO, health maintenance organization, is a health insurance plan that limits coverage to a network of doctors and hospitals. Out of all the four types, this is going to be your most kind of restrictive because it requires you to choose a primary care doctor or a PCP and it needs a referral from a PCP to see specialists. So that's the main reason between an HMO and an EPO. So with an HMO, you are going to need a referral from your primary care doctor to go see that specialist and coverage is limited. Out of network is not covered except in emergencies. Now these plans are typically best for those who want lower costs and don't mind a managed approach to health care because you kind of have your primary care doctor overlooking your health. So that's what an HMO is. What is an EPO plan? So an EPO plan is a exclusive provider organization, is a health insurance plan that provides coverage if you use doctors, specialists, hospitals inside the plans network. So some key features of an EPO plan are that you do not require, you're not required to choose a primary care doctor. Like in an HMO, you have to choose your doctor. Sometimes it's assigned to you, but here you do not have to do that and you do not need any referrals to see a specialist, right? So you don't need any referrals to see specialist doctors and similar to an HMO, the coverage is limited and out of network is not covered except in emergencies. So that's the only real kind of similarity between an EPO and an HMO is that you cannot get care outside of network. It's not going to be covered. So an EPO plan is best for those who want flexibility within a network but prefer lower premiums than those of the PPOs because the PPOs are the most expensive inside the Affordable Care Act, inside the Obamacare. So think of an EPO as kind of a little lesser version of a PPO, but it still gets the job done. It's still very similar to a PPO plan. So the costs, right? Everybody wants to know the cost HMO versus EPO costs. These are without a subsidize thanks to Forbes.com. They made a little article here. So I kind of merged it into this video. So for example, a 21 year old is going to be paying around $342 a month without a subsidize for an HMO plan and a 21 year old is going to be paying $380 a month for an EPO plan monthly. So as you can see here, the costs are just a little bit extra for the EPO just because you kind of get more flexibility with that plan. So as you can see here, these are the costs on the screen. This is without a subsidize. So don't think you're going to pay this much because most households, four out of five households qualify for a $10 a month or less plan. So this is without a subsidize. So keep that in mind. Do not get scared when you see that number. So HMO plan, pros and cons of an HMO plan. The pros, you obviously have the lower monthly premiums, right? Lower out of pocket costs usually. And you will have coordinated care through your PCP because your primary care doctor is overlooking your health, right? So the cons, you're kind of limited to in-network providers, right? You cannot get coverage outside of network and you do require referrals to see specialists. So right off the bat, this is a huge deciding factor. If you don't think you could be without a referral to see a specialist, right? Like that's too much for you, then this plan is just not for you. Even if it's cheaper, right? It's just not going to be for you. You're going to run into that hurdle and you're going to have to spend more time and more money to try and see that specialist. So the EPO plan, the pros and the cons of an EPO plan is that the main, the juicy part here is that you are not required to select a PCP. It is way more affordable than a PPO plan, which is very expensive, but it's obviously the most flexible. So you still kind of get that flexibility while not paying as much. And you do not need any referrals to see specialist doctors. This is the bread and butter. This is why everybody chooses an EPO is that, that right there, that third pro line right there. So the cons is no coverage outside of network except emergencies. Same thing with an HMO and the premiums are going to be higher than their HMO counterpart. So that is going to be the main difference between the two. So lastly, HMO versus EPO, which should you choose? Should you choose an HMO or an EPO? So if you're on a budget, then you have to go with an HMO plan because they simply have lower premiums. Now, if you want flexibility, the EPO lets you see specialists without a PCP, right? So you do not need to do that. A larger network. If you want a larger network, then you go with an EPO because it simply offers more options. It's a bit of a larger network than an HMO, which is kind of more restrictive. And if you do not mind referrals, you don't really care, then HMO because simply it's similar. You just end up saving money with an HMO overall. So one last tip here is check to see if your doctors are in network and choose your plan based on costs, flexibility, and your overall needs, right? Your next door neighbor does not have the same needs as you. So that is pretty much it. So if you want to save money on your plan here, Cuspide Insurance treats you the best. Call the number on the screen here 305-970-8583. The marketplace is open. Hopefully that gives you an idea of which route to take, an HMO or an EPO. In the end, it's all up to you. It's all up to your wants and your needs. So thank you all so much for watching. Make sure to leave a like and subscribe to the channel. I will see you all in another video. Bye-bye.