Plan type affects more than the name
Insurance companies sell several plan structures. The type determines whether you need referrals, whether out-of-network care is covered, and how much flexibility you have when choosing specialists.
Health Maintenance Organization (HMO)
HMOs emphasize a primary care doctor who coordinates your care. Referrals are usually required to see specialists. Out-of-network care is typically not covered except in emergencies.
Trade-off: lower premiums and predictable copays in exchange for less freedom to switch doctors.
Preferred Provider Organization (PPO)
PPOs let you see specialists without referrals and often cover some out-of-network care at a higher cost. Premiums tend to be higher than comparable HMO plans.
Good fit if you travel frequently, split time between locations, or already have specialists you want to keep.
Exclusive Provider Organization (EPO)
EPOs combine network restrictions similar to HMOs with the ability to see specialists without referrals. There is usually no out-of-network coverage except emergencies.
High-Deductible Health Plan (HDHP) with HSA
HDHPs have lower premiums and higher deductibles. Many pair with a Health Savings Account (HSA), which lets you save pre-tax dollars for medical expenses.
These plans work well for people who are generally healthy, want tax advantages, and can afford the deductible if something unexpected happens.
How to choose among plan types
List your regular doctors and medications first. Then compare total estimated cost: premium plus expected copays and deductible. A cheap premium can be expensive if your drugs are not on the formulary.
Our comparison guides walk through public versus private options and family versus individual enrollment.