The four plan types at a glance
| HMO | PPO | EPO | POS | |
|---|---|---|---|---|
| Out-of-network care covered? | No (emergencies only) | Yes, at a higher cost | No (emergencies only) | Yes, at a higher cost |
| Need a primary care doctor? | Usually | No | Sometimes | Yes |
| Referrals for specialists? | Usually | No | Usually not | Yes |
| Typical premium | Lower | Higher | Middle | Middle |
General features. Rules vary by plan, so always check the plan’s summary of benefits. Source: HealthCare.gov.
HMO (Health Maintenance Organization)
An HMO limits coverage to doctors and hospitals that work for or contract with the plan. You usually pick a primary care doctor who coordinates your care and gives referrals to specialists. Out-of-network care isn’t covered except in an emergency. The trade-off for these limits is usually lower premiums and simpler costs.
Good for: people whose doctors are in the network, who are happy to have one doctor coordinate care, and who want lower premiums.
PPO (Preferred Provider Organization)
A PPO pays more when you use in-network providers but still covers out-of-network care at a higher share of the cost. You can see specialists without a referral. That flexibility usually comes with higher premiums, and out-of-network bills can be large, because providers outside the network may charge more than the plan allows.
Good for: people who want to keep a specific doctor who isn’t in an HMO network, travel often, or see several specialists.
Compare health insurance quotes in your area
Enter your ZIP code to see providers near you. Free, no obligation.
Sponsored listings. FindBestInsurance may be paid when you click them.EPO (Exclusive Provider Organization)
An EPO covers services only from providers in its network, except in an emergency, like an HMO. But it usually doesn’t require referrals to see specialists. It’s a middle ground: more freedom than an HMO inside the network, without paying for out-of-network cover you may never use.
POS (Point of Service)
A POS plan works like an HMO for in-network care: you choose a primary care doctor and need referrals. But it also pays something toward out-of-network care, usually with higher costs and a referral.
How to choose
- List your doctors, hospitals and prescriptions, then check each plan’s provider directory and drug list (formulary). This matters more than the plan type label.
- Compare total yearly cost, not just the premium: premiums plus the deductible, copays and the out-of-pocket maximum.
- Think about where you’ll be. HMO and EPO networks are often local. If you split time between states, a PPO may suit you better.
- Check the plan category too. Plan type (HMO or PPO) and metal tier (bronze, silver or gold) are separate choices; see metal tiers explained.
Frequently asked questions
Is an HMO or PPO cheaper?
HMOs usually have lower premiums and simpler costs. PPOs cost more but cover out-of-network care and don’t require referrals.
Can I see a specialist without a referral?
In a PPO and most EPOs, yes. HMOs and POS plans usually require a referral from your primary care doctor.
Does an HMO cover emergencies out of network?
Yes. Emergency care must be covered even at an out-of-network hospital.
What is the difference between an EPO and a PPO?
Both usually skip referrals, but an EPO only covers in-network care (except emergencies), while a PPO also pays toward out-of-network care.
Sources
Figures checked November 7, 2026. Insurance rules and prices change and vary by state and insurer; confirm details with the insurer or your state.