HMO, PPO, EPO, POS—you’ve probably come across at least one of these names before, and perhaps, tuned out immediately. We don’t blame you, this stuff can get tedious, but it’s important to learn about because it could end up saving you some serious $$$. HMO, PPO, EPO, and POS are abbreviations for the plan types available in the individual health insurance marketplace. Each plan type is differentiated by their network (opens in new tab) and coverage (opens in new tab) options, meaning, which doctors you can see and how much you’ll pay.
HMO (Health Maintenance Organization)
HMOs are super common, and you’ve probably heard this acronym before. If you have an HMO, your insurance coverage is usually limited to care from a network of providers that work for or contract with your insurance company. Put simply: If you get care in the network, you’re covered. If you go to someone outside the network, you’re not. Also, if you want to see a specialist, you may need a referral (opens in new tab) from your primary care doctor (opens in new tab), which is sometimes called a "gatekeeper."This may mean having to pay an additional copay for a primary care doctor with the copay you’ll need to pay to see a specialist.
An HMO is right for you if… You’re cool with requiring a primary care doctor to coordinate your care.
PPO (Preferred Provider Organization)
With PPO plans, you’re typically paying more, but you’re getting more choices because you also have the option to see doctors outside of the network. PPO plans require higher cost-sharing (like ) when you see doctors outside their network of preferred doctors, but you generally pay less if you use providers that are in the network because they have with your insurance company. Referrals are not required to see a specialist.