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
|Required to select a primary care physician (PCP)?||Yes||No|
|Out-of-Network Coverage||For medical emergencies only||For 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.