Julie’s Got You Covered

Decoding Health Insurance: Julie Sears Breaks Down HMOs, PPOs, and EPOs

• Julie Sears • Episode 4

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What Are The Key Differences Between An HMO, PPO And EPO Plan?

Unlock the secrets to picking the perfect health insurance plan with Julie Sears on "Julie's Got You Covered." Prepare to unravel the complex world of HMOs, PPOs, and EPOs as Julie, alongside co-host and producer Sophia Yvette, guides you through the maze of health insurance options. With seven years of industry experience, Julie offers her expert advice to help you navigate the intricate details of each plan. From understanding the strict networks of HMOs to the flexibility offered by PPOs and the unique hybrid nature of EPOs, this episode is packed with insights that empower you to make the best insurance choice for your lifestyle, whether you're a frequent traveler or prefer staying close to home.

Join us as Julie shares her knowledge on how demographic factors like age and income can influence your insurance costs and choices. She delves into the benefits and drawbacks of each plan, revealing why certain options may be more financially viable depending on personal circumstances. You'll also learn about potential savings through government tax credits and subsidies. For anyone feeling overwhelmed by the alphabet soup of insurance acronyms, this episode is your essential guide to gaining clarity and confidence in selecting the right health coverage.

To learn more about Integrity Health Insurance Advisors visit:
https://www.IntegrityHealthInsuranceAdvisors.com/
Integrity Health Insurance Advisors
469-348-4066

Speaker 1:

Welcome to Julie's Got you Covered, the podcast where Julie Sears, founder of Integrity Health Insurance Advisors, takes the fear out of finding the right health insurance. With seven plus years of experience, she's here to make finding the perfect coverage a breeze. Stay tuned for details on how you can snag a free 30-minute consultation.

Speaker 2:

Choosing a health insurance plan feels like an alphabet soup of acronyms. Let's break down the differences so you can pick the one that fits you best. Welcome back everyone. I'm Sophia Yvette, co-host, slash producer, back in the studio with julie sears. Julie, how are you today? I'm great. How are you? I'm doing great. So, julie, what are the key differences between an hmo, ppo and epo plan?

Speaker 3:

the differences on EPO and PPO are those are the network, so those are going to be your providers that are offered to you through your plan. So an EPO is going to be a hybrid of the HMO and PPO. So PPO is a preferred provider organization and you can go in and out of network as you choose and you can choose any doctor and if you stay in network and you are going to get preferred rates, but if you do go out of network you'll still have coverage available to you. It just won't be those same deeply discounted HMO has a very strict network of doctors.

Speaker 3:

They have everything goes through your primary care so that way they can funnel and assess whether those specialists are needed and then, once you do get those referrals to the specialist, then you are considered in network and you have your coverage. And an EPO is that hybrid of the two. So they do have a pretty limited network of doctors to choose from. However, you do not have to get those referrals to go to those specialists. However, they do not offer out of network coverage. So you do not have to get those referrals to go to those specialists. However, they do not offer out-of-network coverage. So you do want to make sure that your doctor is in network in order to have that coverage, but you can choose your own.

Speaker 2:

So, Julie, is there a quiz I can take to tell me if I'm an HMO, PPO or EPO kind of person?

Speaker 3:

me if I'm an HMO, ppo or EPO kind of person. Not really a quiz, but I do ask some questions when I talk to families to make sure I kind of know what their lifestyle looks like, what their goals are, what kind of stage in life you're in. So if you like to travel, an HMO may not necessarily be the best fit because your networks are typically limited to either the region or the state that you live in. So then you're going to be out of network quite a bit and everything is out of pocket at that point. Same with an EPO, and the PPO is going to give you the most flexible amount of coverage. But if you're more of a homebody and you like to stay kind of where you are or stay in your state and do a lot of staycations, then those others might be a good fit and offer some savings, typically just because you don't have such an expanded network.

Speaker 2:

Now, that's a good overview of all three plans, but what are the main benefits and drawbacks of each plan?

Speaker 3:

For an HMO, the biggest drawback is the limited network and the fact that you don't have access to those out-of-network doctors unless you want to pay out-of-pocket EPO. The biggest drawback is the lack of out-of-network. Those are just going to be out-of-pocket and it doesn't chip away at that out-of-pocket maximum for the year for you and PPO. Typically the biggest drawback is you might pay a little bit more for that type of coverage but it's going to give you the broadest range and the most flexibility in choosing your own care.

Speaker 2:

So which plan is generally the most affordable?

Speaker 3:

for most people it really just depends, because rates are based on our demographics. So it's going to be based on what state you live in, what the demographics in your area look like, and then your age, and then, of course, depending on your income level, you may qualify for some subsidies and some government tax credits in order to bring those costs down even more. So really is just depending on what you're looking for in that coverage. So you know, if you're looking for just what, if coverage and you qualify for a subsidy, the marketplace plans might be a great fit, because it's just that catastrophic catch all. But you know, if you're like some of my clients that are business owners and they tend to travel either for work or for play, to enjoy their time off, that PPO coverage is worth every penny because they're paying full price and they're going to write it off as a tax deduction, being self-employed, and they're going to have the flexibility to go anywhere they want.

Speaker 2:

Sounds like it pays to know your acronyms, Julie. Are there any major coverage limitations specific to HMO, PPO or EPO plans?

Speaker 3:

No, they're just going to be based on the policy, and it're just going to be based on the policy and it's just going to be based on the policy that you purchase and what each of those look like, getting into the nitty gritty and what the offering is on that specific plan.

Speaker 2:

Is picking a plan like ordering coffee. Do I need to know my exact flavor to get what I want?

Speaker 3:

Knowing what you use it for is definitely most important kind of what's most important to you. So if you know you're getting your annual exams, you're going to be covered. If you like to get extra lab work just to keep track of your numbers and make sure that you're staying relatively healthy and monitoring your health that way, you want to make sure that we've got good coverage for those diagnostic type things. So, yeah, knowing the extras that you want in your coffee will definitely come in handy. Narrowing down, because just in our zip code here locally you can have over a hundred plans offered with a really big range in those premiums. So you definitely want to make sure we look at the things that you specifically want covered, because you don't always just want to buy on price because that could bite you in the end.

Speaker 2:

Love it, Julie. We'll catch you in the next episode. Have a fantastic rest of your day.

Speaker 3:

You too.

Speaker 1:

Thanks for tuning in to. Julie's Got you Covered. Ready to say goodbye to insurance stress Head to integrityhealthinsuranceadvisorscom or call 469-348-4066. That's 469-348-4066 to book your free 30-minute consultation With Julie. Health insurance doesn't have to be scary. She's got you covered.