The letters on a health plan describe the rules for which doctors you can see and what happens if you go outside the network. They affect your costs more than most people expect.
PPO
A PPO (preferred provider organization) lets you see in-network or out-of-network doctors, usually without a referral. In-network care costs less. Out-of-network care is often covered at a lower rate, with higher costs to you.
Tends to fit: people who want choice, see specialists, or travel.
HMO
An HMO (health maintenance organization) generally keeps you inside its network. You pick a primary care doctor, and you usually need a referral to see a specialist. Care outside the network is typically not covered except in emergencies.
Tends to fit: people who are comfortable with one main doctor and want lower premiums.
EPO
An EPO (exclusive provider organization) is in-network only like an HMO, but often without referral requirements.
Tends to fit: people who don't need out-of-network care and don't want referral steps.
POS
A POS (point of service) plan blends the two. You choose a primary care doctor and need referrals, but you can go out of network for a higher cost.
Side by side
| PPO | HMO | EPO | POS | |
|---|---|---|---|---|
| Out-of-network care | Covered, costs more | Usually not covered | Usually not covered | Covered, costs more |
| Referral to see a specialist | Usually no | Usually yes | Usually no | Usually yes |
| Primary care doctor required | No | Yes | Often no | Yes |
| Premiums | Often higher | Often lower | Often lower | In between |
These are general patterns. Individual plans vary, so read the plan details.
How to choose
Start with your doctors. If a doctor you want to keep is in one plan's network and not another's, that often decides it. See our guide on how to check a doctor's network. Then compare the full year's cost, not just the premium, using the deductible and out-of-pocket guide.
This article is general information, not a guarantee of coverage or pricing. Plan availability, benefits, and eligibility vary by state and individual. Some private plans are medically underwritten and do not include all ACA essential health benefits.