Having choices is good for consumers. Imagine if we lived in a world in which we all had to wear the exact same clothing, or if we only had one song we could listen to, or if we all had to drive the same vehicle. Not only would that be a boring world, but our limited options would also limit our freedom to live the lives we want.
Health insurance is no different.
Some people value lower cost, some people value greater provider access. That’s why insurers offer different plans like Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPO)s.
But right now, North Carolina law does not allow the full breadth of options enjoyed in other states. Exclusive Provider Organizations (EPOs) are currently allowed for small groups in most other states – but not North Carolina.
EPOs actually are an option for large groups, but not for small groups. That means that government regulation is currently preventing small businesses enjoying the same cost-saving benefits of EPOs that large businesses enjoy.
What is an EPO?
An EPO is an insurance plan that controls the cost of premiums by limiting the provider network – kind of like a traditional HMO. Also like an HMO, they don’t offer any coverage for out-of-network providers except in the case of emergencies – a feature that helps control the cost of premiums.
But unlike HMOs, EPOs are designed for greater flexibility. They are great for people who are more inclined to travel for work or pleasure or small businesses that have workers in multiple states - or would if they could provide an EPO as an insurance option. They’re the right plan for people who want lower cost options but need the same health coverage and financial security when they are on the road as they can expect at home.
Unfortunately, without new legislation, EPOs will continue to remain completely unavailable to North Carolinians in the coming year.