What You Need to Know About Plan Types

July 13, 2016

There are several types of plans to choose from in the health insurance marketplace. You might notice that many plans have 3-letter codes in their names: HMO, PPO, EPO, or POS.

Those letters tell you a little bit about what kind of provider options you have under that plan. A provider is a doctor, hospital, pharmacy, or other person or place you visit to get health care services. Here’s a little more about each type of plan:

  • Exclusive Provider Organization (EPO): EPO plans only cover services if you see doctors and other health care providers that are in-network, unless there’s an emergency. While you don’t need a referral to see a specialist, your plan might have fewer providers in-network for you to choose from.
  • Health Maintenance Organization (HMO): Often, an HMO plan only covers doctors and hospitals that are in-network, unless there’s an emergency. You may need a referral from your primary care provider to see a specialist. Many HMOs focus on preventive care and wellness.
  • Point of Service (POS): POS plans often require you to get a referral from your primary care doctor before seeing a specialist. Often, you pay less if you see doctors and other health care providers who are in-network.
  • Preferred Provider Organization (PPO): PPO plans often do not require you to get a referral from your primary care doctor before seeing a specialist. Often, you pay less if you see doctors and other health care providers who are in-network.

Before you pick a plan, it’s a good idea to make sure your doctors and hospitals are included in the plan’s provider network. You can check by calling your doctor or hospital and asking if they accept the plan.

Need a hand comparing health insurance plans? Check out the Plan Explorer.

Get started

Get Started

Sign up to learn more about your health insurance options

Your Health. Your Choice.

Enroll Now

We're here to help you on your journey to get covered. We’ll connect you to your state's Health Insurance Marketplace and let you know what to expect once you get there.

Get Enrolled

About Us

Our passionate staff is dedicated to helping people learn their health insurance options.

Volunteer With Us

Get Covered America is a grassroots campaign powered by volunteers. Sign up now to volunteer!

Image of an assister helping someone get enrolled with health insurance

Partner with Us

If you're an organization interested in partnering with us, you can learn about opportunities here.