How do the four plan types differ?
| Plan type | Out-of-network care | Referral to see a specialist | Good to know |
|---|---|---|---|
| HMO (Health Maintenance Organization) | Usually not covered, except in an emergency | Check the plan's rules | Usually limits coverage to doctors who work for or contract with the plan. May require you to live or work in its service area. |
| EPO (Exclusive Provider Organization) | Not covered, except in an emergency | Check the plan's rules | Covers only doctors, specialists and hospitals in the plan's network. |
| PPO (Preferred Provider Organization) | Covered, for a higher cost | Not needed | You pay less in the network. |
| POS (Point of Service) | Covered, for a higher cost | Needed from your primary care doctor | You pay less in the network. |
Which type is best for me?
If you want the most choice and are willing to pay more for it, a PPO usually gives the most freedom. If your doctors and hospitals are all in one network and you want to keep costs down, an HMO or EPO can work well. If you travel often or split time between places, check the plan's service area and what it covers away from home.
Any of these types can be sold at any metal level, so the plan type and the bronze, silver, gold or platinum level are separate choices.
What should I check before I enroll?
Search the plan's provider directory for your own doctors and hospitals, and look up your prescriptions on the plan's drug list. Directories can be out of date, so call the doctor's office to confirm they accept the specific plan. A licensed agent can check this with you before you choose.
See our Individual & Family plans
Major medical coverage for you and your household, with subsidies applied where you qualify.Health plan comparison calculator: yearly cost of two plans
Enter two plans' premiums, deductibles and out of pocket maximums to see which costs less for the care you expect.
Talk to a licensed agent
We compare plans, explain the tradeoffs and help you enroll. It costs you nothing.