HMO vs PPO vs EPO vs POS: What's the Difference? Prices, Services & More

Plans available to you on the ACA Marketplace are plentiful, but knowing which is right for you is difficult. HMO vs PPO vs EPO vs POS. These are all available to you, but what do they stand for, and more importantly, how much will the monthly premium cost? We’ll answer all your questions about each plan including coverage options and more.

If you need to find which plan is right for you now, call one of our well-informed agents at (855) 968-5736. We are available every weekday from 9 a.m. to 5 p.m. and are happy to help guide you through the Marketplace. Not ready to talk to an agent? We have a free, unique quoting tool that will give you an accurate price for various plans on the Marketplace.

Here’s how you can know the difference between HMO vs PPO vs EPO vs POS plans on the Marketplace:

What is an HMO?

A Health Maintenance Organization (HMO) is a health insurance plan that provides coverage for care from doctors in the specific HMO. You will choose one primary care physician (PCP) who will refer you to specialists if necessary. They will be the primary point of contact for your healthcare.

Some HMO plans on the Federal Marketplace allow you to see a specialist outside your PCP recommendation, but those plans are rare. Check your policy to discover which plan you have.

Generally, HMOs have a lower monthly premium and out-of-pocket costs, but out-of-network coverage is not covered except in an emergency. The purpose of an HMO is to provide coverage for those looking for prevention and wellness.

What is a PPO?

A Preferred Provider Organization (PPO) is a health insurance plan that allows you to pick from any healthcare provider and even includes coverage for some out-of-network costs. Your network is typically larger than an HMO, but it does come at higher monthly premiums and out-of-pocket costs.

While you have the option to pursue out-of-network providers, it will be cheaper to choose in-network providers. You might even have to pay a separate deductible for out-of-network costs.

PPOs are best for those who have chronic conditions that require more flexible and specialized plans.

What is an EPO?

Exclusive Provider Organizations (EPOs) are similar to an HMO plan. However, you will not need to select a PCP or get a referral to see a specialist.

Out-of-network costs are not covered, but emergency services are an exception. Generally, you’ll get a specific list of providers covered by insurance.

What is a POS?

A Point of Service (POS) plan is an insurance plan that mixes both HMO and PPO plans. You’ll still pay less for in-network providers and need a referral from your PCP to see a specialist. A POS will also cover out-of-network services, but they will have higher copayments and coinsurance.

What Are the Different Levels of Health Insurance Plans?

Generally, there are four levels of health insurance plans: Bronze, Silver, Gold, and Platinum. Availability will depend on where you live, and the higher quality of metal associated with the plan, the more coverage you have.

You can switch between different plans during the Open Enrollment Period (Nov. 1 to Jan. 15) or a Special Enrollment Period.

HMO vs PPO vs EPO vs POS: Every Difference

While each plan is slightly different, each one will give you the health coverage you need. Here are all the differences for each plan — including the average prices:

	HMO	PPO	EPO	POS
Out-of-Network Services	Only in Emergencies	Yes	Only in Emergencies	Yes
Referrals for Specialists	Yes	No	No	Yes
Average Monthly Premium for 50-Year-Old w/ $50,000 Income (No Subsidy)	$660.31	$925.07	$684.65	$845.87
Average Monthly Premium for 5-Year-Old w/ $15,000 Income (No Subsidy)	$665.28	$925.09	$682.75	$845.87

*Prices and plan availability heavily depend on your location, age, and income.

As you can see, HMO plans have the least flexibility but are cheaper than the other plans, and PPO plans offer the most flexibility at the highest price point.

For exact subsidy information, call us at (855) 968-5736 or use our quoting tool to discover what you’d be paying based on your income and age.

What Health Insurance Plan is the Best?

Determining which health insurance plan is best for you depends on many factors. How much are you willing to spend on an insurance plan? Do you have a chronic illness that needs specialist care? Are you planning on getting out-of-network services?

Each plan has pros and cons, and it’s up to you to determine your needs. Or you can call us at (855) 968-5736, and we will help you find a plan that works for your needs and budget. You can even browse the Federal Marketplace with our unique quoting tool that helps you see plans with accurate prices based on age, location, and income.

Conclusion

There isn’t a perfect, catch-all health plan. HMO vs PPO vs EPO vs POS… There are options for you to consider for each plan available in your area. If you are uncertain which plan is right, call us at (855) 968-5736. Our talented agents are available every weekday from Monday to Friday from 9 a.m. to 5 p.m. They are experts at navigating the Marketplace and are eager to help find a plan catered to your needs.

We even have a free quoting tool that shows you what plans are available based on your income, location, and age.

Frequently Asked Questions

Are HMO or PPO Plans Better?

It depends on your needs. If you use health insurance for general checkups, an HMO would be the best for you. A PPO is suggested for those who are suffering from chronic illnesses or if you anticipate seeing a specialist often.

Where Can I Buy a Health Insurance Plan?

You can find a health insurance plan on the Federal Marketplace. If you need help navigating, call us at (855) 968-5736, and our talented agents will guide you through the different plans available to you.

Are EPOs and PPOs The Same?

No, EPOs and PPOs are not the same. While both plans don’t require you to go to a PCP to see a specialist, out-of-network services are only available to PPOs.