HMO vs PPO vs EPO: what is the difference?
The letters tell you which doctors you can see and whether you need a referral. Here is how they compare.
Last checked October 24, 2026 · Written by licensed advisors · Sources are numbered and listed under Notes and sources
What does PPO mean?
PPO stands for preferred provider organization. A PPO lets you see any doctor without a referral and pays more when you use doctors in its network.1
- Preferred provider organization
- No referral needed
- Pays more in network
- Usually a higher premium
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The short answer
An HMO keeps you inside its network and usually needs a referral from your primary doctor before you see a specialist. A PPO lets you see any doctor without a referral and pays something out of network, for a higher price. An EPO sits between them: no referrals, but no coverage out of network except emergencies.1
Side by side
How the common plan types usually work. Each plan sets its own rules, including referrals, so check the plan’s summary of benefits.1
| Plan type | Referral for specialists? | Out of network covered? |
|---|---|---|
| HMO | Usually yes | No, except emergencies |
| EPO | Usually no | No, except emergencies |
| PPO | No | Yes, at a higher cost |
| POS | Usually yes | Yes, at a higher cost |
Who each one fits
An HMO or EPO fits people whose doctors are all in the network and who want a lower premium. A PPO fits people who travel, live near a state line, or want to keep a doctor who is out of network, and are willing to pay more for it.
Which types you can choose from depends on where you live; in some areas the Marketplace offers few or no PPOs.1
- All your doctors are in the network
- You want a lower premium
- You travel or live near a state line
- You want to keep an out-of-network doctor
- You’ll pay more for it
How to check a doctor is in network before you pick
Search each plan’s provider directory by the plan’s exact name, not just the insurer: one insurer can sell several networks. Then call the doctor’s office and ask whether it takes that exact plan for 2027. Check your prescriptions on the plan’s drug list too.23
- 1. ListYour doctors, hospitals and prescriptions
- 2. SearchEach plan’s provider directory, by the plan’s exact name
- 3. CallThe doctor’s office: ask about that exact plan for 2027 (key step)
- 4. Check drugsThe plan’s drug list (formulary)
What to do: Send us your list of doctors and prescriptions, and we check them against every plan you are considering.
Metal level and network type are different
Bronze, silver and gold tell you how you and the plan split the cost of care. HMO, PPO and EPO tell you which doctors you can see and whether you need referrals. A silver HMO and a silver PPO pay the same share of costs on average, with different networks and rules.4
- How you and the plan split the cost of care
- Sets the premium and deductible range
- Which doctors you can see
- Whether you need referrals
Keep in mind
A network can change from year to year, and a doctor in one insurer’s network may not be in another’s. Out-of-network bills on an HMO or EPO usually aren’t covered at all, except emergencies.5
What to do: Before you enroll, list your doctors, hospitals and prescriptions. We check each plan’s network and drug list with you.
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Obamacare Hotline and/or Medicare Po Polsku are private companies not affiliated with any local, state, or federal government agency. This guide is general information, not tax or legal advice.