If you have health insurance or are even just shopping for coverage, you have likely come across the term “network” or “provider network.” You may have seen acronyms like HMO, PPO, EPO, POS or HDHP — but it may not be completely clear how choosing one over the other changes access to medical care and may affect out-of-pocket costs.
Which insurance is most affordable? Which health insurance plan is right for you? For a lot of people who get their health insurance through their employer, it comes down to what options are available if there's more than one choice.
Frequently asked questions about health plans
Explore these common questions to learn more about the different types of health plans and how they work.
Compare HMO, PPO, EPO and POS plans
| HMO Plans | PPO Plans | EPO Plans | POS Plans | |
|---|---|---|---|---|
| Overview | HMO plans typically require you to choose a primary provider, or primary care physician (PCP), in the HMO plan network. This provider will refer you to other network providers as needed. Premiums are often lower because of the defined network which can help control costs. These plans may also offer low or no deductible options. | PPO plans tend to give you more flexibility to choose the providers you prefer to visit for care. If you choose an out-of-network provider, you’ll likely pay more. Premiums tend to be higher and are commonly paired with a deductible. | EPO plans generally let you see any network provider you choose. There’s no requirement to choose a primary care physician or get referrals to see a specialist. These plans do not offer out-of-network benefits. | POS plans usually require you to get referrals to see specialists. Most plans will have some coverage for out-of-network care — often with a higher copay. These plans are like a combination of an HMO and PPO plan. |
| Doctor/provider details | Providers or doctors either work for the HMO or contract for set rates. | Networks include providers and facilities that have negotiated lower rates on the services they perform. PPO health plans have access to those negotiated rates. | Doctors and facilities that participate in an EPO are paid per service. They don’t directly work for or contract with the EPO carrier for a set rate. Instead, they have negotiated lower rates on services they perform for plan members. | Network providers have negotiated rates on medical services for members with a POS health plan. |
| Network vs out-of-network care | For most plans, you’re required to use health care facilities or doctors that are in the HMO network. Out-of-network care is typically allowed in emergency cases only. | When you choose a provider in the network, you may have lower out-of-pocket costs than if you choose out-of-network providers. Out-of-network care is usually included in the benefit plan, but it may be at a reduced level of coverage and benefits. | May restrict your coverage to care in the plan network. Out-of-network coverage may only be available for emergencies. | Coverage is generally for care in the plan network for services. Out-of-network services may be authorized in limited cases. Benefits and coverage for out-of-network care may be less than if you stay in the plan network. |
| Referrals | With most plans, you’ll need to choose a PCP. This PCP is your main health care contact and care is often coordinated through them. You may need to get a referral from your PCP to see a specialist. | It's less likely that you’d need to choose a PCP and less likely to need a referral to see a specialist. But some plans may require this, so check the network requirements to understand the details of your plan. | It's less likely that you’ll be required to have a PCP or get a referral to see a specialist. Generally, you can get care from any provider if you stay in the plan network. | Often a PCP will coordinate your health care. You’ll need referrals from your PCP to see a specialist or go out-of-network for care. |
| Preapprovals | You may need to get advanced approval before having certain medical services performed. In many cases preapproval will be handled through your PCP, if you have one. | Almost every network requires preapprovals for some medical services. Because a PPO plan gives more freedom to choose your preferred providers, you may need to get more preapprovals. | Preapprovals are more likely needed before having certain health care services, because you’re not required to have a PCP overseeing your care. | Some health care services will need preapproval. However, if you have A PCP, they will often take care of preapprovals for you. |
