Guide · Life & health insurance

HMO, PPO, EPO and POS plans

The plan type decides which providers you can see and whether you need referrals. It matters as much as the price.

4 min read · Last reviewed 2026-10

These are general patterns. Each plan sets its own rules, so confirm the details in the plan's Summary of Benefits and Coverage and its provider directory.

Plan type	Network	Referrals	Out-of-network care
HMO	Care generally must come from in-network providers	Often need a primary care doctor and referrals to specialists	Generally limited to emergencies
PPO	Larger network with more flexibility	Usually not required for specialists	Generally covered, at a higher cost to you
EPO	In-network providers only	Usually not required	Generally limited to emergencies
POS	Blend of HMO and PPO features	Often need a primary care doctor and referrals	Some coverage, at a higher cost to you

How to choose

List the doctors, specialists and hospitals you want to keep.
Check each plan's provider directory for them, and ask the plan to confirm.
Consider how often you see specialists and whether you travel.
Compare the total cost, including deductible and out-of-pocket maximum, not only the premium.

Why networks matter

Out-of-network care usually costs more or may not be covered, apart from emergencies. HealthCare.gov's glossary notes that out-of-network coinsurance usually costs you more than in-network coinsurance.

Questions

Can the network change during the year?

Providers can join or leave a network. Confirm your providers before you enroll and again before major care.

Which type is cheapest?

It varies by plan and area. Compare total costs for the plans available to you.

Sources

Informational only. Rules and policy terms change and differ by state and insurer. Confirm details with your policy, your insurer or your state insurance department.

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How the ACA Marketplace worksThe Marketplace is where you can compare and enroll in individual health plans. Which site you use depends on your state.

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Beneficiaries explainedYour beneficiary designation decides who receives the death benefit. A few minutes of review can prevent serious problems later.

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