What to know about HMO, PPO, EPO, and POS plans
The basics of health plan types
Although health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are the most common health insurance plan types, they aren't the only ones. There are two other types called exclusive provider organizations (EPOs) and point of service (POS) plans.
Each plan type has its own features and network rules that make them unique and useful for certain kinds of people.
How plan type differences matter
HMO and POS plans require you to select a PCP. This doctor serves as your first point of contact, and they will connect you to specialists and testing as needed.
Having a PCP gives you a long-term relationship with a doctor who knows and understands your health history. They can also help coordinate your care across other doctors and help you stay on top of preventive care.
With PPO and EPO plans, you can usually book an appointment with a specialist on your own. You don't need to get a referral.
This gives you more control over when to see specialists for health issues that require different kinds of care than a PCP can give. It's still up to you to find an in-network specialist, though.
Every plan works with a set of doctors and hospitals called a network. Staying in-network usually means lower costs for you. PPO and POS plans provide some coverage for doctors outside your network, but you'll pay more. HMO and EPO plans will only cover doctors in your network.
The amount of flexibility you want to get coverage at any doctor can impact what kind of plan you pick.
Figuring out the right type of plan for you
There can be a lot to think about when choosing a plan. Here are some factors to consider to make sure that you're selecting the right plan for you.
- Preferred doctors. If you have a favorite doctor or specialist, make sure they are included in the plan's network.
- Frequency of care. How often do you see a doctor? Consider network size, deductibles, and copays for the full picture.
- Travel habits. HMO and EPO plans usually have local networks. If you travel often, a plan with a larger network or out‑of‑network coverage may give you more flexibility.
- Budget. Balance the monthly premium with how much medical care you think you might need this year and the potential costs.
The right plan for you is the one that fits your needs. If you want lower costs and don't mind staying in-network, an HMO or EPO may be a good fit. If you want more flexibility to see doctors outside the network, a PPO or POS might be right.
