Question 7 of 15
HMO, EPO or PPO. Three letters in the plan name decide what happens when you see a provider outside the plan’s list.
You are enrolled in an HMO. You choose to see a specialist who is not in the plan’s network, and it is not an emergency. What will the plan most likely pay?
Correct. Not quite. HMO and EPO plans generally cover non-emergency care only from providers in their network. Out-of-network care that you choose is typically not covered at all, and what you pay does not count toward the out-of-pocket maximum. PPO plans usually pay part of out-of-network charges, at a lower rate and with a separate deductible. Many low-priced Marketplace plans are HMOs or EPOs with regional networks.
More: Your Doctor Takes Your Insurance, Right? Don’t Be So Sure