HMOs, PPOs, EPOs… oh my! With so many types of health insurance plans out there, it’s easy to feel overwhelmed. Understanding what each plan offers, and the potential drawbacks, can help you make a confident, informed decision about your health coverage.
With open enrollment just around the corner, now’s the perfect time to review your options. To make things easier, we’ve broken down the most common plan types with a quick list of pros and cons.
HMO (Health Maintenance Organization)
Pros:
- Lower out-of-pocket costs when you stay in-network
- Simplified care coordination through your primary care physician (PCP)
Cons:
- You’ll need a referral from your PCP to see most specialists
- Coverage is limited to in-network providers
PPO (Preferred Provider Organization)
Pros:
- Flexibility to see specialists without a referral
- Out-of-network coverage available (though at a higher cost)
Cons:
- Generally higher premiums and out-of-pocket costs
POS (Point of Service)
Pros:
- Option to see out-of-network providers
- Lower costs when you stay in-network
Cons:
- Often requires a referral from your primary care physician to see a specialist
EPO (Exclusive Provider Organization)
Pros:
- No referrals needed to see specialists
- Lower premiums compared to PPO plans
Cons:
- No coverage outside your plan’s network (except in emergencies)
Finding the right health insurance plan can feel like a challenge, but you don’t have to navigate it alone. Health Plans of America connects you with licensed insurance professionals who can help you compare options, find savings, and get answers to all your health coverage questions.
Whether you’re exploring new plans, renewing your coverage, or just looking for expert advice, Health Plans of America is here to help you make the right choice.