What are the differences between HMO, PPO, EPO, and POS plans?

Let's review the types of plans you may see, depending on what's available in your area. Each type of health plan is designed to meet different needs. 

• An HMO (or “health maintenance organization”) requires you to choose a primary care physician (PCP) who acts as your "gatekeeper." Think of your PCP as your personal healthcare quarterback, coordinating your care and handling your basic healthcare needs. If you need to see a specialist or get a diagnostic service, such as a blood test, you'll need a referral from your PCP. Your referral will be to a provider within your HMO network. If you see a doctor outside the network or without a referral, you'll generally have to pay the full cost yourself unless it's a true medical emergency or you have no other options. With an HMO, your physician network is local.
• A PPO (or “preferred provider organization”) is a health plan with a “preferred” network of providers in your area. You don't need to choose a primary care physician or get referrals to see a specialist. If you see a “preferred” (or “in-network”) provider, you'll only be responsible for part of the bill, based on your plan's coverage. If you choose to see a doctor outside the preferred network, you'll generally pay more than you would for an in-network provider, although most plans will still cover part of the bill. With a PPO, you'll also have access to out-of-state providers who are considered in-network.
• An EPO (or “exclusive provider organization”) is somewhat like a combination of an HMO and a PPO. EPOs generally offer a little more flexibility than HMOs and tend to cost a bit less than PPOs. Like a PPO, you don't need a referral to see a specialist. But like an HMO, you'll be responsible for paying out of pocket if you get care from a doctor outside your plan's network. An EPO may be a good choice if you want to see specialists within your network without a PCP referral.
• A POS (or "point of service”) plan is also a combination of an HMO and PPO. Like an HMO, you'll need a referral from your PCP to see a specialist. But like a PPO, you'll pay less when you use doctors, hospitals, and other healthcare providers in your plan’s network. You'll also have access to out-of-network providers, but at a higher cost.

If you want more health insurance tips and know-how, check out our handy insurance guide here: The Stride Guide to Health Insurance

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