What's the difference between an HMO, PPO, and EPO?

There are three types of health plans: HMO, PPO, and EPO plans. These plans primarily vary in accessibility and size of physician network. In order to pick the right plan, you should know the differences.
 

An HMO is generally the most affordable, but least flexible network type

  • You are required to select a primary care physician who is your first-stop for health needs. You will need a referral from your primary care physician to see a specialist.
  • If you choose to see a doctor outside of the network or without a referral, you will generally have to pay all costs out-of-pocket unless it is a true medical emergency or you have no other options.
  • The physician network is local.

A PPO is generally the most flexible, yet most expensive network type

  • You do not need to select a primary care physician and you do not need referrals to see a specialist.
  • If you see an in-network provider, you will only be responsible for paying a portion of the bill (based on your plan's coverage structure).
  • If you choose to see a doctor who is outside the preferred network, you will generally have to pay a larger portion of the bill than you would for an in-network provider.

  • You will have access to out-of-state providers that are considered in-network.

An EPO is a hybrid of a HMO and a PPO

  • EPOs are more flexible than an HMO, and are typically less expensive than a PPO.
  • Like a PPO, you do not need a referral to get care from a specialist.
  • Like an HMO, you are responsible for paying out-of-pocket if you seek care from a doctor outside your plan's network.
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