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CA Department of Insurance

Compare PPOs. EPOs, and HMOs

Categories PPO EPO HMO
Network You pay less to see providers in your plan's network. These are called preferred providers. You get covered care from the doctors, hospitals, and other providers in your plan's network. You get care from the doctors, labs, and other providers in your plan's network.
Out-of-Network You can go out-of-network, but you pay more. You can go out-of-network, but you will pay the full our-of-pocket costs for the service. The only exception is if you have an emergency or need urgent care. You cannot see providers out-of-network except in an emergency or if your plan gives you pre-approval.
Primary Care Doctor You may not be required to have a primary care doctor. You may not have to use a primary care doctor. You must have a primary care doctor. This is the doctor you must usually see first when you need care.
Referrals You may be able to get many health services without a referral. You do not need to get referrals to see specialists if they are in the EPO's network. You need referrals to see specialists or to get lab tests.
Pre-approval You may be able to get many health services without pre-approval. You will need pre-approval from your health plan before you can get any services. You will need pre-approval from your health plan before you can get many health services.
Costs

You may have a yearly deductible.

You may also have deductibles for hospital care and prescription drugs.

Care in the network costs a lot less than care outside the network.

You are likely to have higher out-of-pocket expenses.

You are less likely to have a yearly deductible.

You usually pay a co-pay or flat fee for most services.

You are less likely to have a yearly deductible.

You usually pay a co-pay or flat fee for most services.

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