Health Insurance Basics

Health Insurance Network Types – PPO vs. HMO vs. EPO vs. POS

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 Fewer Restrictions
HMO EPO   POS       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
Health Maintenance Organization (HMO)
  • Limited network of doctors
  • Require an assigned Primary Care Physician
  • PCP must refer you to specialists
  • You pay full price if you go out of network (no coverage)
Exclusive Provider Organization (EPO)
  • Larger group of doctors
  • No referrals needed to see a specialist
  • You pay full price if you go out of network (no coverage)
Point of Sale (POS)
  • Larger group of accessible doctors
  • No referrals needed to see a specialist
  • Discounted copays if you use a dedicated network of doctors
  • You will receive some coverage if you go out of network*
Preferred Provider Organization (PPO)
  • Largest group of accessible doctors
  • You will receive some coverage if you go out of network*
Indemnity
  • Can go to any provider or health care organization

*While POS and PPO plans do provide out of network coverage, these services are typically subject to higher deductibles and coinsurance rates, so we always recommend trying to stay in-network wherever possible.

If you have any further questions, use the live chat function on your quote to chat with our team of experts!

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