What Are HMO and PPO Plans?
HMO and PPO refer to the type of provider network your health insurance uses. The network determines which doctors, hospitals, and specialists you can see — and how much you'll pay when you do.
HMO (Health Maintenance Organization)
- Must choose a primary care physician (PCP)
- Need a referral from your PCP to see specialists
- No coverage for out-of-network care (except emergencies)
- Lower premiums and copays
- Best for people who don't mind staying in-network and want lower costs
PPO (Preferred Provider Organization)
- No PCP required — see any doctor
- No referrals needed for specialists
- Out-of-network care is covered (at a higher cost)
- Higher premiums but more flexibility
- Best for people who want choice and don't mind paying more for it
EPO: The Middle Ground
An EPO (Exclusive Provider Organization) combines features of both: no referrals needed (like PPO), but no out-of-network coverage (like HMO). Often priced between HMO and PPO.
Side-by-Side Comparison
HMO: Lower cost, less flexibility. Need referrals, must stay in-network.
PPO: Higher cost, more flexibility. See anyone, no referrals.
EPO: Mid cost, mid flexibility. No referrals, but must stay in-network.
How to choose: If you have doctors you love who are in-network, an HMO saves money. If you travel frequently, see specialists regularly, or want the freedom to see any doctor without a referral, a PPO is worth the extra premium. Check which network type your preferred doctors accept before choosing.
HMO, PPO, and EPO plan types are available on both the ACA marketplace and through private carriers. The network type is separate from the metal tier — you can get an HMO Silver plan or a PPO Silver plan.
Related Terms
Last updated: March 30, 2026.
