Health Insurance Plans: HMOs, PPOs, and More
There are different types of Health Insurance Marketplace plans designed to meet different needs. Some types of plans restrict your provider choices or encourage you to get care from the plan's network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan's network.
Types of Marketplace Plans
Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level—Bronze, Silver, Gold, and Platinum. Here are some examples of plan types you'll find in the Health Insurance Marketplace:
- Exclusive Provider Organization (EPO) is a managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan's network (except in an emergency).
- Health Maintenance Organization (HMO) is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
- Point of Service (POS) is a type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
- Preferred Provider Organization (PPO) is a type of health plan where you pay less if you use providers in the plan's network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
U.S. Centers for Medicare & Medicaid Services (CMS), Health Insurance Marketplace. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more. Retrieved June 21, 2024, from https://www.healthcare.gov