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What is an EPO Insurance Plan and How Can It Benefit You?

You’ve probably heard the term EPO before, but you might not know what it means. EPO stands for exclusive provider organization, and it is one of many different kinds of health insurance plans available in the United States today. Read on to learn more about this type of plan and how it can benefit you and your family.

What is an EPO


An Employee Purchase Option (EPO) plan allows employees to purchase health insurance coverage through their company, in order to save money on their monthly premiums. Employees contribute pre-tax income into a health savings account (HSA), which can then be used to cover healthcare expenses without incurring taxes or penalties.

Unlike some other health benefits provided by employers, employee contributions into an HSA are non-taxable. Employers typically contribute a set amount towards each employees’ HSA based on salary level, while employees can put in as much as they would like up to certain limits. Some employers even provide additional incentives for high contribution amounts!

Who needs it


These plans are best for people who travel frequently on business or for their jobs. They tend to be very specific about what you can use your benefits on, so if you can’t come up with a list of specific places where you travel for work (airline tickets, hotels, rental cars) then it might not be worth paying extra to have coverage that won’t help you much.

If you have family in different states or are moving a lot over a few years, an EPO may be helpful. If you don’t need to use your insurance often—say once every three years—an annual plan will likely be cheaper than buying one every month or two when you do need it.

Advantages of having a plan


If you get injured at work or get sick, many insurance plans can help to pay for medical bills, along with some living expenses. And in some cases, having health insurance can save you money on your taxes because it helps reduce how much you pay each year in Social Security taxes. The coverage from a health insurance plan isn’t free; it’s usually tied to your job or salary. To cover those costs, employers may collect a set dollar amount per paycheck, which could be higher if you’re older or have a chronic condition that requires expensive care. All of these benefits mean that people who don’t have any type of health insurance plan might be tempted to buy one—but just like anything else in life, not all plans are created equal.

Does it cover prescriptions


An EPO plan provides you with coverage for prescribed drugs, as well as over-the-counter medications, with no copay. In some instances, a deductible may apply. As long as your doctor writes a prescription for any of your treatments or medications (even if they are covered by Medicare), you’re free to pick up anything at your local pharmacy. This makes prescription drugs cheaper when compared to paying cash up front at a retail pharmacy—even if you don’t have insurance otherwise.

Does it cover doctor visits


An EPO insurance plan covers you from primary care to specialty providers. Primary care physicians, such as internists, pediatricians or family medicine doctors, can provide for all of your medical needs. They’re capable of diagnosing ailments, prescribing medication and ordering diagnostic tests—in essence, performing most of the same services covered by specialist care. However, if your condition requires a more specific type of treatment than what primary care physicians can offer you, then you would need to see a specialist for diagnosis and treatment. In these cases where specialization is needed or in times when you need continuous medical attention that exceeds basic outpatient visits with your PCP (primary care physician), then it’s a good idea to look into an HMO insurance plan instead.

Is there a limit on how much you can claim per month


The deductible for an Individual Preferred Provider Organization (PPO) plan is a flat dollar amount. Once you’ve spent that much money on covered medical services, including pharmacy costs, you’re no longer responsible for any additional expenses. Your monthly premium will remain steady regardless of how many services you use in a given month. With some HMO plans, your cost per service can change based on how many services you use each month. In other words, if you make five different claims over a five-month period, your total premiums could be higher than someone who used fewer services in that same time frame.

What are the costs associated with getting this type of insurance


When getting any type of insurance plan, it’s important to understand your options and how much they will cost. This can be anything from monthly fees to taxes or fees that are incurred when you make a claim. Knowing exactly what you’re paying for in advance will allow you to better manage your budget while also determining whether it’s worth it to pay extra or if you can get a cheaper alternative. Remember, there are many insurance agents out there who will try to sell you their product regardless of what’s right for your particular needs.

Eligibility criteria to enroll in the program


Employees must be employed full-time. Employees who work 30 hours or more per week are eligible for coverage, but employees who work less than 30 hours per week may not be eligible for coverage. This depends on a number of factors, including how many other qualified employees are enrolled in your employer’s program. Part-time employees should inquire with their employers about eligibility under their plan; it may differ from those listed here.

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