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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


PPO vs. EPO for My Daughter?

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Question: I live in Santa Cruz and currently have double insurance. Medicare(disability) and Blue Shield Stand-Alone PPO SMall Group. I needed to keep the PPO because I have a minor daughter and Medicare does not cover minors. I noticed that Blue Shield will only have an EPO. My daughter will be going off to college next year. What is the difference between an EPO and PPO? I want to be able to select my own drs. I do not know where my daughter will be going to college but it will be in CA. Should I consider getting her a separate plan ? What plan would you recommend for me? Will the small group business plans continue under Blue Shield?

Answer: Your daughter’s best option is a PPO because that would give her access to any PPO provider throughout the state. The EPO is only good for the local network with emergency-only coverage out-of-network. Your employer sponsored Blue Shield plan will remain a legacy (full) PPO network until the next plan renewal. At that time your employer can choose a Health Net narrow network PPO if the Shield EPO network is not satisfactory. Your employer could also choose SHOP coverage through Covered California, which would allow each employee to choose either Health Net PPO or Blue Shield EPO.

1 Comment

There are two main differences between a PPO and an EPO. The first, as you pointed out is the flexibility to go outside the network.

The second difference is an EPO has a smaller network of providers to choose from. Phil, you made the EPO sound more like an HMO. It is actually more like a PPO with the above noted differences.

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