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HMOs vs. EPOs

Discussion in 'Anything goes' started by PhilaYank36, Dec 27, 2007.

  1. PhilaYank36

    PhilaYank36 Guest

    I'm about to get dropped from my parents' COBRA health coverage at the end of the month, and I'm scrambling to get some form of health insurance. I have a bit of an injury history and a couple meds I need to take daily, just for some background. My biggest questions are these:

    • What are HMOs and EPOs?
    • Which is better?

    If anyone can give some advice, that would be great.
  2. BigDog

    BigDog Active Member

    You have to take a couple meds just for some background?
  3. alleyallen

    alleyallen Guest

    Ah...finally, a thread that speaks to me. When I left newspapers I went into benefits...specifically, health insurance. So, here's the deal...

    EPOs are very similar to HMOs in that you MUST designate one doctor (usually not a specialist) who will coordinate all your care. That means if you need to see a specialist, you first have to see that main doctor (called a primary care physician, or a PCP) and get a referral to a specialist. If you don't the cost of the visit to the specialist usually isn't covered. HMOs are the same way, but much more stringent.

    The key difference is in- and out-of-network benefits. In an HMO, there are NO out-of-network benefits at all. If you see a specialist who isn't in the network, you'll pay it all yourself. With an EPO, there may indeed be out-of-network benefits, particularly regarding seeing a specialist.

    The plus side to both plans? The cost per paycheck usually isn't very much, and you pay no deductible typically. The copays are a set amount and aren't usually that much. The down side is the PCP requirement, the necessity of referrals (instead of the freedom to just make an appointment with a specialist) and the restrictive nature of the network. They're trade-offs.

    One is NOT better than the other, plain and simple. Think about your needs and how important it is to you to have a bit more freedom in terms of going out of network if need be (for example, if you're traveling and staying at some other location for a few weeks).
  4. BigDog

    BigDog Active Member

    I hope they didn't change the rules on PhilaYank at midseason. Only losers do that.
  5. alleyallen

    alleyallen Guest

    Change the rules?
  6. SoCalDude

    SoCalDude Active Member

    If you can get a mail-in prescription program, that'll save you about two-thirds of the cost. You get a 3-month supply for about the same price as a one-month supply from the corner drug store.
  7. PhilaYank36

    PhilaYank36 Guest

    That sounds good, but what are the catches? How do you know you're getting the right thing? I remember reading a good piece from the Philly Inquirer about some internet pharma-scam, and that was one of the first things that popped up in my head.
  8. alleyallen

    alleyallen Guest

    Those are definitely things to avoid. What he meant was each legit RX carrier (usually aligned with your medical plan as what's called a "carve out") offers mail-order prescription services. And he's right...it's usually cheaper, although it only works for maintenance drugs. For example, you may pay $30 for a one-month supply but only $60 for a three-month supply through mail order.

    And trust me...done through your insurance company, it shouldn't be a scam.
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