HMO vs PPO vs EPO vs POS — what's the difference?

HealthCare.gov says plan types differ in how they treat your choice of doctor. Some cover only the plan's network, or push you toward it. Others pay a bigger share for doctors outside it. Which types you can find depends on how many plans are sold in your area. At each metal level you may see all of them, or only some [1].

HealthCare.gov's own definitions [1]: • EPO (Exclusive Provider Organization) — a managed care plan. Care is covered only inside the plan's network of doctors, specialists and hospitals. An emergency is the exception. • HMO (Health Maintenance Organization) — usually limits cover to doctors who work for the HMO or contract with it. It generally pays nothing outside the network, except in an emergency. It may require you to live or work in its service area. • POS (Point of Service) — you pay less inside the plan's network. You need a referral from your primary care doctor to see a specialist. • PPO (Preferred Provider Organization) — you pay less inside the network. You may go outside it without a referral, at a higher cost.

So two questions separate them. Does the plan pay anything outside its network? And do you need a referral to see a specialist? This answer does not say which type to pick. That turns on which doctors you want to keep, and what you will pay to keep them.

What it costs. The page quoted here does not give prices for the plan types. We have no official average we can show you yet.

Read the «Health insurance plan & network types» page at healthcare.gov, then search each plan's provider directory for your own doctors and read its rules on referrals and out-of-network care.