Health insurance HMO PPO

Types of Health Insurance

Your insurance company probably has several different plans that they can put you under. Which plan is right for you may depend on how much you want to pay, how complicated you want your healthcare to be, and how much choice you want to pick a specialist or healthcare provider. Learn more about some different plans below!


Health Maintenance Organization


A health maintenance organization plan, or HMO, provides the insured with a large network of different healthcare providers, which grants access to a wide variety of services and facilities. However, it is incredibly difficult to get access to providers who are outside of the network of the HMO. Individuals and families covered under an HMO pay monthly premiums, have a deductible, and typically have a flat-fee copay, but may also have a coinsurance plan where the insured pays a percentage of costs.



  • The insured is allotted a primary physician who will refer them to any specialists that they may need, within the network.
  • Less paperwork for a wide network of healthcare providers.
  • Less freedom to pick health care providers that are outside of the network.


Preferred Provider Organization


A preferred provider organization plan, or a PPO, is quite similar to an HMO, in that there is a network of healthcare providers that are covered by the plan. However, there is still the freedom of choice to see a provider outside of the network. That being said, it comes with high costs and complications. Insured parties covered under a PPO pay monthly premiums, have variable deductibles (depending on if the provider is in or out-of-network), and have higher copays and fees to see providers outside their network.



  • The insured has a decent amount of choice, with regards to choosing their health care providers, as they don’t need a primary physician referral to see a specialist of their choice.
  • There are higher costs to the insured, when they do see doctors and specialists outside of the PPO network.
  • When seeing a healthcare provider out of the network, there is a considerable amount of paperwork.


Exclusive Provider Organization

An exclusive provider organization, or an EPO, is like an HMO, but provides a larger network that extends between the local network of the HMO. Because the network is larger, and provides a wider variety of specialists and healthcare providers, seeing any provider outside the network requires that the insured pay the full cost of care, themselves. However, the premiums are considerably cheaper than an HMO or PPO. Insured parties covered under an EPO pay monthly premiums, have a deductible, and have standard in-network copays.


  • Lower premiums than the PPO offered by the provider.
  • Has zero coverage for healthcare providers that are outside of the network, except in rare types of emergencies.
  • Provides a larger network of providers and specialists than a HMO, thus offering more choice.


Point-of-Service Plan

A point-of-service plan, or a POS, is kind of like a hybrid between an HMO and a PPO, in that there is more freedom to see providers outside the network, but at a lower price. Under this plan, there aren’t as many strict rules about seeing out-of-network healthcare providers, and only a moderate difference in price. Insured parties under a POS plan pay monthly premiums, have a deductible, and have variable copays and coinsurances, depending on if the doctor is in or out-of-network.


  • There is more freedom to pick an out-of-network provider than in an HMO, but less than in a PPO.
  • There is complicated paperwork to see an out-of-network provider, but less than in a PPO.
  • Your primary physician can refer you to in-network providers and specialists, for a lower cost than an out-of-network alternative.