HMO vs. PPO vs. EPO vs. POS: Which Health Plan Type Fits You?
Learning goal: Tell the four common health plan types apart by network rules and referrals, and pick the one that fits the doctors you use and how much choice you need.
Short answer
The main difference is the network. HMOs and EPOs generally pay only for in-network care, except emergencies. PPOs let you go out of network for an additional cost, without referrals. POS plans pay less out of network and need a referral to see a specialist. PPOs usually cost more for that flexibility.
Read to the end to complete this lesson.
On this page
The Fuller Picture
HealthCare.gov lists these as the common plan types, offered at each metal level. If you have doctors you want to keep, check whether they're in network for each plan, not just the insurer. If you travel often or live in two places, an HMO's service area matters. If you see specialists often, referral rules add steps.
Key Takeaways
- HealthCare.gov: an EPO covers services "only if you use doctors, specialists, or hospitals in the plan's network (except in an emergency)."
- An HMO generally won't cover out-of-network care except in an emergency, and may require you to live or work in its service area.
- With a PPO, you can use out-of-network providers without a referral, for an additional cost.
- POS plans require a referral from your primary care doctor to see a specialist.
- Each plan type can be found at Bronze, Silver, Gold and Platinum levels.
Real-World Example
Lena
Lena sees an endocrinologist several times a year and wants to keep her. Two Silver plans have similar premiums: an HMO and a PPO. Her endocrinologist is in the PPO's network but not the HMO's. Under the HMO, those visits wouldn't be paid except in an emergency, so Lena picks the PPO, after confirming by phone that the doctor takes that specific plan.
Common Mistakes
- Choosing on premium without checking your doctors are in network.
- Assuming an in-network hospital means all its doctors are in network.
- Missing referral rules on HMO and POS plans.
- Forgetting an HMO's service area if you live part of the year elsewhere.
Interactive Exercise
Check Your Doctors Against Each Plan
For each plan you're considering, check these before comparing prices.
Tick each step as you do it. Your checklist is saved in this browser.
Knowledge Check
Question: Which plan type generally lets you see out-of-network providers without a referral, for an additional cost?
Recommended Insurpedia Tools
- Insurance Preparedness Checklist: Twelve insurance questions worth having an answer to, with a place to learn more about each one you have not looked at yet. No score.
Related Insurance Terms
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Questions to explore next
Questions readers often ask next about this topic:
- Which plan type fits the doctors I already see?
- How do I confirm a doctor is in network for a specific plan?
- Does my plan need referrals for specialists?
- What does the plan pay out of network?
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The factual claims on this page were checked against these sources. Rules and figures change, so check the source itself if you need to confirm the current version.
- healthcare.govHealth insurance plan & network types: HMOs, PPOs, and more · HealthCare.gov (U.S. Centers for Medicare & Medicaid Services)
Educational information, not advice: This lesson is for general education only, not legal, financial, or insurance advice. Actual coverage, discounts, and requirements depend on your policy’s wording, your insurer, and the laws of your state. Confirm specifics with your own insurer or a licensed agent before making a decision. Insurpedia does not sell insurance and does not recommend specific insurers. Plan type descriptions are from HealthCare.gov's plan and network types page. Networks and rules vary by plan and change over time. Educational information, not advice on a specific plan.