The main types of health insurance plans available on the ACA Marketplace are HMOs, PPOs, EPOs, and POS plans. Each one structures your access to doctors and your cost-sharing differently, so understanding the differences can save you money and frustration.
Plan Types: What Each One Means for Your Family
HMO (Health Maintenance Organization)
An HMO requires you to choose a primary care physician (PCP) who coordinates all your care. You need a referral from your PCP to see a specialist. In-network only, meaning out-of-network care is not covered except in emergencies. HMOs typically have the lowest premiums and are a good fit for families who want lower monthly costs and don't mind using a specific network of providers.
PPO (Preferred Provider Organization)
A PPO gives you more flexibility. You can see any doctor or specialist without a referral, and out-of-network care is covered (at a higher cost share). PPOs usually have higher monthly premiums. They're a good choice if your family has specialists you want to keep seeing, or if you travel frequently and want coverage outside a fixed network.
EPO (Exclusive Provider Organization)
An EPO is a hybrid. Like an HMO, it only covers in-network care (except emergencies). But like a PPO, you don't need referrals to see a specialist. EPOs can offer good value if you're comfortable staying in-network but want the freedom to self-refer to specialists.
POS (Point of Service)
A POS plan combines elements of an HMO and PPO. You choose a primary care doctor and need referrals for specialist visits, but you can go out of network for a higher cost. Less common on the ACA Marketplace than the other three types.
Regardless of which type you choose, all ACA Marketplace plans cover the same 10 Essential Health Benefits and all protect you against pre-existing condition exclusions. The plan type affects your access and cost structure, not what conditions are covered.
Not sure which type fits your family? Call us at (305) 330-1277 or See your plan options and we'll match you to the right plan type for how your family actually uses healthcare.
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