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.
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HSA Plans (Health Savings Account)<\/h3>\r\n

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Both EPO and HMO plans can be high deductible health plans that are designed for people with a health savings account.<\/p>\r\n \r\n

<\/p>\r\n\r\n

    \r\n \t
  • HSA plans have lower monthly premiums and higher deductibles. HSA plans are also called High Deductible Health Plans.<\/li>\r\n \t
  • 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.<\/li>\r\n \t
  • 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.<\/li>\r\n \t
  • 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.<\/li>\r\n<\/ul>\r\n“, “_green_call_out”: “field_5d483cecdbcad” }, “align”: “full”, “mode”: “edit” } /–>

     Brokers can recommend which plan is right for you

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

    Find a certified broker near you »

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.
\r\n

HSA Plans (Health Savings Account)<\/h3>\r\n

<\/p>\r\n

Both EPO and HMO plans can be high deductible health plans that are designed for people with a health savings account.<\/p>\r\n \r\n

<\/p>\r\n\r\n

    \r\n \t
  • HSA plans have lower monthly premiums and higher deductibles. HSA plans are also called High Deductible Health Plans.<\/li>\r\n \t
  • 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.<\/li>\r\n \t
  • 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.<\/li>\r\n \t
  • 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.<\/li>\r\n<\/ul>\r\n“, “_green_call_out”: “field_5d483cecdbcad” }, “align”: “full”, “mode”: “edit” } /–>

     Brokers can recommend which plan is right for you

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

    Find a certified broker near you »