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The four main plan types
| HMO | PPO | EPO | POS | |
|---|---|---|---|---|
| Out-of-network cover | No (except emergencies) | Yes, at higher cost | No (except emergencies) | Often yes, at higher cost |
| Referral to see a specialist | Usually required | Not required | Usually not required | Required |
| Primary care doctor required | Usually | No | Sometimes | Yes |
| Premiums | Lower | Higher | Lower to moderate | Moderate |
| Best for | People happy to stay in network to save money | People who want flexibility or see out-of-area doctors | People who want in-network savings without referrals | People who like a coordinating doctor but want some out-of-network cover |
Based on HealthCare.gov plan type definitions. Rules vary by plan, so read the summary of benefits.
HMO: Health Maintenance Organization
HealthCare.gov describes an HMO as a plan that “usually limits coverage to care from doctors who work for or contract with the HMO.” Out-of-network care generally isn’t covered except in emergencies. Most HMOs ask you to choose a primary care doctor who coordinates care and gives referrals to specialists. In return, premiums and cost-sharing are usually lower. Integrated systems such as Kaiser Permanente work this way.
PPO: Preferred Provider Organization
With a PPO, you pay less for in-network providers, but you can see doctors and hospitals outside the network without a referral, for an extra cost. That flexibility suits people who travel, have family in different states or want to keep a specific specialist. PPOs remain the most common employer plan type, covering 46% of covered workers in 2025.
EPO: Exclusive Provider Organization
An EPO covers services only if you use the plan’s network, except in emergencies, but usually doesn’t require referrals. EPOs are common on the Marketplace because they let insurers keep premiums down.
POS: Point of Service
With a POS plan you pay less in network and need a referral from your primary care doctor to see a specialist. Some POS plans cover out-of-network care at a higher cost. POS plans covered 9% of covered workers in 2025.
Where high-deductible plans fit
A high-deductible health plan (HDHP) can be any network type; it’s defined by its deductible. One in three covered workers was in an HDHP with a savings option in 2025. Pairing one with a health savings account can make it cost-effective; see our cost guide.
Out-of-network surprises
Even in a PPO, out-of-network care costs more, and providers may bill you for the difference between their charge and what the plan pays. Federal surprise-billing protections limit this for most emergency care and for some care at in-network hospitals, but not for every situation. Always check network status before planned care.
How to choose
- List your doctors, hospitals and prescriptions, and check them in each plan’s directory.
- Think about where you get care: if you split time between states, a PPO may be worth it.
- Compare total yearly cost for your expected use, not just premiums.
- Consider how much coordination you want. Some people value a primary care doctor managing referrals; others find it a hassle.
Our guide to the best health insurance companies covers insurer quality and availability, and our Marketplace guide explains metal tiers.
Frequently asked questions
Is an HMO or PPO better?
An HMO is usually cheaper if you’re happy using its network and a primary care doctor. A PPO is better if you want out-of-network cover or no referrals.
Do PPOs require referrals?
No. You can see specialists, in or out of network, without a referral, though out-of-network care costs more.
What is an EPO plan?
A plan that covers only in-network care (except emergencies), usually without referrals. It combines HMO-style networks with PPO-style access to specialists.
What is the most common type of health plan?
PPOs, covering 46% of workers with employer coverage in 2025, according to KFF.
Are emergencies covered out of network?
Yes. HMOs, EPOs and other plans must cover emergency care at out-of-network hospitals, and federal rules limit surprise bills for most emergencies.
Sources
- HealthCare.gov – Health plan and network types
- KFF – 2025 Employer Health Benefits Survey: summary of findings
- KFF – Family premiums for employer coverage rise 6% in 2025
- HealthCare.gov – Preventive care benefits
- CMS – 23.1 million enroll in 2026 Marketplace coverage (Mar 2026)
Insurance prices, discounts and rules change often and vary by state. Figures were checked in October 2026; confirm details with the insurer or your state insurance department.