Health insurance is confusing enough, at least according to my clients. People had almost figured out the difference between and HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization) and now you have the EPO thrown into the mix.
EPOs are not new--these have a couple of different names but we'll use Exclusive Provider Organization. Often when an insurance company has a special geographic area, or they need a special network, they will institute an EPO. Here's why this term is important in Los Angeles County for health care reform and what I refer to as the 'brave new world.'
The plans being offered in L.A. County are limited in the Covered California exchange, as they are throughout the state. Here's what the two main players in our area, Blue Shield of California and Anthem Blue Cross, are offering in the Covered California exchange:
- Blue Shield will be offering PPOs only--but before you think you're in the clear, realize that overall the provider networks will be smaller. This will not be the full Blue Shield network you are accustomed to.
- Anthem will be offering a couple of HMO plans, which traditionally have smaller networks than PPOs, and an EPO plan or two. The EPO plans will have the same network as the PPO plans, according to an Anthem meeting I went to yesterday. Where the difference is, on an EPO plan, there are NO out of network benefits.
So what does this mean for you? Pretty much all the networks are being reduced for individual plans. I'm accustomed to checking network availability for my clients, but now it is even more crucial. You will also have Health Net, L.A. Care and Molina Health Care in L.A. County, but those plans for individuals are all HMO.
So the takeaway from this? Check your doctors, check your hospitals, realize that your choice is decreased in many of the new plans, but if you are eligible for premium assistance, aka subsidies, this is where you need to buy if you want to take advantage of this. And then what's available outside of Covered California? We're still waiting to hear for sure, as the approvals are pending. So, once again, stay tuned!