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Network Guide

Plan Types Explained

HMO, PPO, EPO, POS — these acronyms describe how your insurance network works and affect how you access care.

Quick Comparison
FeatureHMOPPOEPOPOS
Need PCP?YesNoNoYes
Need Referrals?YesNoNoYes
Out-of-Network?No*YesNo*Yes
PremiumsLowerHigherModerateModerate
FlexibilityLowHighModerateModerate

* Except for emergencies, which are covered regardless of network.

Each Plan Type Explained

HMOHealth Maintenance Organization
A managed care plan that requires you to choose a primary care physician (PCP) and get referrals to see specialists.

Key Feature: Requires PCP and referrals

Advantages

  • Lower premiums and out-of-pocket costs
  • Coordinated care through your PCP
  • Predictable copays
  • Focus on preventive care

Disadvantages

  • Must stay in-network (except emergencies)
  • Need referrals to see specialists
  • Less flexibility in choosing providers
  • May need to change doctors if you switch plans

Best for: People who want lower costs and don't mind coordinating care through a PCP.

PPOPreferred Provider Organization
A flexible plan that lets you see any provider but gives you better rates for in-network care. No referrals needed.

Key Feature: Flexibility without referrals

Advantages

  • See any doctor without referrals
  • Out-of-network coverage available
  • Don't need a PCP
  • Good for people who travel

Disadvantages

  • Higher premiums
  • Higher out-of-pocket costs
  • Out-of-network care is expensive
  • More complex billing

Best for: People who want flexibility, see specialists often, or have doctors they don't want to change.

EPOExclusive Provider Organization
Similar to an HMO but typically doesn't require referrals. You must stay in-network except for emergencies.

Key Feature: In-network only, no referrals

Advantages

  • Lower premiums than PPO
  • No referrals needed for specialists
  • Simpler than HMO rules
  • Good network coverage

Disadvantages

  • No out-of-network coverage
  • Less flexibility than PPO
  • Must use network providers
  • May have smaller networks

Best for: People who want some flexibility without PPO prices and are comfortable staying in-network.

POSPoint of Service
A hybrid of HMO and PPO. You have a PCP and need referrals, but can go out-of-network at higher cost.

Key Feature: HMO + PPO hybrid

Advantages

  • Can see out-of-network providers
  • Coordinated care through PCP
  • More flexibility than HMO
  • Lower in-network costs

Disadvantages

  • Need referrals from PCP
  • Higher costs than HMO
  • Out-of-network is expensive
  • More complex rules

Best for: People who want coordinated care but occasional flexibility to go out-of-network.

How to Choose

Ask yourself these questions:

  • 1Do I have doctors I want to keep? Check if they're in the plan's network. If not, you may need a PPO.
  • 2Do I see specialists often? If yes, PPO or EPO may be easier since you won't need referrals.
  • 3Is budget my top priority? HMO plans usually have the lowest premiums and out-of-pocket costs.
  • 4Do I travel frequently? PPO plans offer better coverage when you're away from home.
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