Updated November 2026. HMO, PPO, EPO and POS are the four network types you will see on almost every health insurance plan, whether it comes from an employer, the ACA Marketplace or Medicare Advantage. The letters tell you two things: whether the plan pays anything for out-of-network care, and whether you need a referral to see a specialist. Those two rules decide how much a plan costs and how much freedom you have to pick doctors.
This guide compares the four types side by side, shows how common each one is, and explains how to choose.
The Short Answer
- HMO (Health Maintenance Organization): in-network care only, and a primary care doctor usually must refer you to specialists. Lowest premiums in most markets.
- EPO (Exclusive Provider Organization): in-network care only, but no referrals needed. Premiums usually fall between HMO and PPO.
- PPO (Preferred Provider Organization): pays for in-network and out-of-network care, no referrals. Highest premiums, most flexibility.
- POS (Point of Service): a hybrid. You pick a primary care doctor and need referrals, but the plan pays something toward out-of-network care.
In every type, emergency care is covered at in-network cost sharing, under the ACA and the No Surprises Act, even at an out-of-network hospital.
HMO vs PPO vs EPO vs POS Compared
| Feature | HMO | EPO | PPO | POS |
|---|---|---|---|---|
| Out-of-network coverage (non-emergency) | No | No | Yes, at higher cost | Yes, at higher cost |
| Primary care doctor required | Usually | No | No | Yes |
| Referral to see a specialist | Usually | No | No | Usually |
| Typical premium | Lowest | Low to middle | Highest | Middle |
| Balance billing risk | Low if you stay in network | Low if you stay in network | Higher when you go out of network | Higher when you go out of network |
| Best for | People happy with a local network | People who want direct specialist access at a lower price | People with doctors in several networks or states | People who want a coordinator plus a safety valve |
How Common Each Plan Type Is
At work, the PPO still dominates. Among workers with employer coverage in 2025, 46% were in a PPO, 33% in a high-deductible plan, 12% in an HMO and 9% in a POS plan, according to the KFF 2025 Employer Health Benefits Survey. High-deductible plans can use any of these networks; the survey counts them separately.
The individual market looks very different. Only about 14% of 2025 Marketplace plans were PPOs, according to a Robert Wood Johnson Foundation analysis, and most enrollees are in HMO or EPO plans. Insurers selling on HealthCare.gov and state exchanges keep premiums down by using narrower networks, so a PPO may not be offered in your county at all.
HMO: Lowest Cost, Most Rules
An HMO pays only for doctors and hospitals in its network. You choose a primary care physician (PCP), who handles routine care and refers you to specialists. Kaiser Permanente is the best-known example; it employs or contracts with its own medical groups.
The trade-off is simple. You give up choice and accept a referral step, and in exchange you usually pay the lowest premium and the lowest copays. If your doctors are in the network and you rarely leave your area, an HMO is often the best value.
EPO: No Referrals, No Out-of-Network Coverage
An EPO works like an HMO without the gatekeeper. You can book a dermatologist or orthopedist directly, but the plan pays nothing if that specialist is outside the network. EPOs are common on the Marketplace, where insurers want the premium savings of a closed network without the referral paperwork.
Read the provider directory carefully before you enroll. With an EPO, one out-of-network specialist can cost you the full bill.
PPO: Flexibility at a Price
A PPO pays for out-of-network care, typically at a lower rate and with a separate, higher deductible and out-of-pocket maximum. No PCP or referrals are required. PPOs suit people who travel, split time between states, or see specialists at academic medical centers that are not in every network.
Out-of-network care under a PPO can still be expensive. The plan pays a share of its “allowed amount,” and the provider can bill you for the difference, a practice called balance billing, outside emergencies and the other situations the No Surprises Act protects.
POS: A Hybrid
A POS plan asks you to pick a PCP and get referrals, like an HMO, but it pays something for out-of-network care, like a PPO. POS plans are less common and mostly offered by employers.
How To Choose
- List your doctors, hospitals and pharmacies, then check each one in the plan’s provider directory.
- Compare the total yearly cost: twelve months of premiums plus the deductible and likely copays.
- Check the deductible and out-of-pocket maximum for both in-network and out-of-network care.
- Ask whether specialists need referrals and how long referrals take to approve.
- If you live in two states part of the year, look for a PPO with a national network.
For help comparing coverage, see our guides to individual health insurance plans and high-deductible health plans. Before you choose an insurer, check how often it turns down claims in our claim denial rankings.
Sources
KFF, 2025 Employer Health Benefits Survey; Robert Wood Johnson Foundation analysis of 2025 Marketplace plan networks; HealthCare.gov glossary; No Surprises Act (Consolidated Appropriations Act, 2021).