HDHP, PPO, HMO, EPO and POS: How Health Plan Types Differ
The letters in front of a health plan describe how it manages where you can get care and who you must see first. They are different from the metal tiers (bronze, silver, gold, platinum), which describe how costs are shared. A plan can be a gold HMO or a bronze PPO, and a high-deductible plan can have an HMO or PPO network. This guide covers the five plan types you will meet during open enrollment, what each means for your freedom to choose doctors, and who it suits.
HMO: Health Maintenance Organization
An HMO has a defined network of doctors, hospitals and specialists. You generally choose a primary care provider (PCP), who coordinates your care and refers you to specialists in the network. Care outside the network is usually not covered at all except for emergencies. In exchange, HMOs often have the lowest premiums and low copays, and less paperwork because in-network claims are handled directly. Best for: people who are happy with the doctors in the network, live inside the plan’s service area and like having one doctor coordinate their care. Watch for: referral requirements, limited coverage when you travel and narrower specialist choice.
PPO: Preferred Provider Organization
A PPO has a network of preferred providers, but it also pays something toward care from outside the network, usually at higher coinsurance and often with a separate, higher deductible. You do not need to choose a PCP and you can usually see specialists without a referral. Best for: people who want choice, who see specialists often, who live in more than one place or who have a doctor who is not in any lower-cost network. Watch for: higher premiums, and out-of-network claims that may mean paperwork and balance bills.
EPO: Exclusive Provider Organization
An EPO sits between the two. Like an HMO, it generally covers only in-network care (except for emergencies). Like a PPO, it does not usually require a PCP or referrals to see network specialists. Premiums are typically lower than a PPO. Best for: people who have confirmed their doctors are in the network and who want to see specialists without the referral step. Watch for: zero coverage out of network, which can be a big surprise when you travel.
POS: Point of Service
A POS plan blends the HMO and PPO. You pick a PCP and get referrals for specialists, as with an HMO, but you can go out of network for a higher cost, as with a PPO. They are less common than the other types on the Marketplace but still show up in employer plans.
HDHP: High Deductible Health Plan
An HDHP is a different dimension from the others: it describes the cost-sharing, not the network. An HDHP has a higher deductible than a traditional plan, and in exchange, the premium is lower. If the plan also meets IRS rules, it is “HSA-eligible,” so you may contribute to a health savings account. For 2027, the IRS requires:
| Self-only | Family | |
|---|---|---|
| Minimum deductible, 2026 | $1,700 | $3,400 |
| Maximum out-of-pocket, 2026 | $8,500 | $17,000 |
| Minimum deductible, 2027 | $1,750 | $3,500 |
| Maximum out-of-pocket, 2027 | $8,700 | $17,400 |
| HSA contribution limit, 2026 | $4,400 | $8,750 |
| HSA contribution limit, 2027 | $4,500 | $9,000 |
The plan can be an HMO, PPO or any other type, as long as it meets those deductible and maximum rules. With very few exceptions (such as preventive care), you pay the full negotiated price until the deductible is met. Best for: households that are relatively healthy, have the cash to cover the deductible in a bad year and want the tax benefits of an HSA. Watch for: the cash-flow risk in a year with a large unplanned medical bill, and the temptation to skip needed care because it feels expensive.
At a glance
| Type | Out-of-network coverage | PCP required | Referrals | Typical premium |
|---|---|---|---|---|
| HMO | Emergencies only | Yes | Yes | Lowest |
| EPO | Emergencies only | Usually no | Usually no | Low to moderate |
| POS | Yes, at higher cost | Yes | Yes | Moderate |
| PPO | Yes, at higher cost | No | No | Highest |
These are general patterns; each insurer varies. Always read the plan’s Summary of Benefits and Coverage.
How to decide
- Start with your doctors and hospital. If a particular specialist or hospital system matters to you, find out which networks include it. That one fact often eliminates half the plans.
- Think about where you spend the year. A college student who lives in another state for nine months, or a family that travels, should be wary of HMOs and EPOs.
- Match the cost-sharing to your risk and your cash. A high-deductible plan is a bet that you will use little care; you need the cash cushion for when you lose that bet.
- Run the numbers. The plan comparison calculator shows yearly cost for an HMO-style plan against an HDHP across quiet, typical and expensive years.
Narrow and tiered networks
Some plans use a “narrow” network, with fewer hospitals and doctors in exchange for a lower premium, or a “tiered” network, where providers in a preferred tier cost you less. The plan type label does not tell you that. Check the directory for the hospital you would use in an emergency and the specialists you see.
Emergency care in any plan
Federal law requires plans to cover emergency services without prior approval and without a higher charge for out-of-network emergency providers. For out-of-network doctors at in-network hospitals, the No Surprises Act also limits what you can be billed. That protection does not extend to planned, non-emergency care that you choose to get out of network.
Common questions people ask before choosing
Does an HMO give worse care? No. The plan type governs how the plan pays, not the quality of the clinicians. Is a PPO always worth the extra premium? Only if you will use the out-of-network benefit or value being free of referrals. Many people pay for a PPO and never leave the network. If my doctor is in the PPO network, do I need the PPO? Not necessarily; the same doctor may also be in an EPO or HMO network from the same insurer, so check each. Are children covered differently? Pediatric services are an essential health benefit in ACA plans, but the network of pediatric specialists and children’s hospitals varies a lot. For families with a child who needs ongoing specialty care, the hospital network can be the most important factor of all.