One of the most common questions we get at SimplyInsured is “What is the difference between an HMO and a PPO?” We’ve created a simple table to help understand. First – some definitions:

Network Type: A general label for the “level of restriction” of plan, and the level of coverage provided in-network and out-of-network. Common types include PPO, HMO, EPO, Network, POS, and Indemnity.

Cliff Notes version:

More Restrictions Less Restrictions
HMO POS EPO PPO Indemnity

Detailed version:

A few decades ago when health insurance was relatively new – these terms used to describe clear characteristics about how your plan would pay for doctor’s visits, preventive care, and out-of-network care. Unfortunately, in today’s world – the lines between plan types has been blurring, and it’s important to check the detailed plan terms to figure out what’s going on. We’ve created a “Cheat Sheet” that gives the major implications of each plan type:

Network Type In Network
Restrictions
Out Of Network
Restrictions
More Restrictions
Less Restrictions
Health Maintenance Organization (HMO)
  • Can visit ONLY specific doctors
  • Require a Primary Care Physician
  • No coverage
Point of Sale (POS)
  • Can visit ONLY specific doctors
  • Require a Primary Care Physician
  • Lower coverage for out-of-network providers
Exclusive Provider Organization (EPO)
  • Large group of accessible doctors
  • No coverage
Preferred Provider Organization (PPO)
  • Large group of accessible doctors
  • Lower coverage for out-of-network providers
Indemnity Can go to ANY provider or health care organization

If you are looking for a new health insurance plan – please check out SimplyInsured – we make it easy to find the best plan for you!

This information is provided as a general guide to insurance – it may not specifically apply to your insurance plan. Please check with your insurance provider for the exact details of your plan.