Types of Health Insurance Plans

Connect for Health Colorado sells two types of health plans:

  • HMOs: Health Maintenance Organization plans 
  • EPOs: Exclusive Provider Organization plans

HMOs and EPOs are most different in:

  • Whether you need a referral from a primary care doctor to see a specialist
  • The location of hospitals and doctors that are in-network
Healthcare servicesHMOEPO
Required to select a primary care physician (PCP)?YesNo
Out-of-Network CoverageFor medical emergencies onlyFor medical emergencies only
Referrals needed to see a specialist?Yes (With some exceptions)No (With some exceptions)

 HMO Plans (Health Maintenance Organization)

HMOs often focus on prevention and wellness. 

  • With an HMO plan, you must choose an in-network Primary Care Physician (PCP).
  • You will coordinate all of your care through your PCP to other in-network providers. So, if you need a specialist, such as a cardiologist (heart doctor), you’ll need to visit your PCP first for a referral to a cardiologist.
    • Some HMOs DO NOT require a referral to see a specialist, so be sure to check your plan. 
  • HMOs DO NOT cover any out-of-network healthcare costs, except in an emergency.

 EPO Plans (Exclusive Provider Organization)

  • In an EPO plan you are typically able to see a specialist without a referral. 
    • Some EPOs DO require a referral to see a specialist so, be sure to check your plan.)
  • Like HMO plans, EPO plans also DO NOT cover any out-of-network healthcare costs, except in an emergency.

HSA Plans (Health Savings Account)

Both EPO and HMO plans can be high deductible health plans that are designed for people with a health savings account.

 

  • HSA plans have lower monthly premiums and higher deductibles. HSA plans are also called High Deductible Health Plans.
  • If you have an HSA plan you should also have a Health Savings Account to help you pay for any health related expenses. HSA plans do not pay for medical costs until the deductible is met.
  • Some bronze level HSA plans have NO cost sharing for health related costs until you reach your deductible (which are higher for HSA plans). You would be responsible for 100% of the cost of going to the doctor until you reach your deductible.
  • You can open an HSA through your bank or other financial institution. Connect for Health Colorado does not open an HSA for members enrolled in an HSA eligible plan.

 Brokers can recommend which plan is right for you

Contact one of our certified Brokers to walk you through it.

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