The different types of private health insurance
All private health insurance plans, whether they’re on-exchange or off-exchange, work by partnering with networks of health care providers. But the way that these plans work with the networks can vary significantly, and you want to make sure you understand the differences between these plans.
HMO: Health Maintenance Organization
HMO plans are the most restrictive type of plan when it comes to accessing your network of providers. If you have an HMO plan, you’ll be asked to choose a primary care physician (PCP) that is in-network. All of your care will be coordinated by your PCP, and you’ll need a referral from your PCP to see a specialist. HMOs do not cover any out-of-network health care costs.
HMO plans typically have cheaper premiums than other types of private health insurance plans.
PPO: Preferred Provider Organization
PPO plans are the least restrictive type of plan when it comes to accessing your network of providers and getting care from outside the plan’s network. Typically, you have the option between choosing between an in-network doctor, who can you see at a lower cost, or an out-of-network doctor at a higher cost. You don’t need a referral to see a specialist, though you may still choose a primary care physician. (Some states may require that you have a primary care physician).
PPO plans typically have more expensive premiums than other types of private health insurance plans.
EPO: Exclusive Provider Organization
EPO plans are a mix between HMO plans and PPO plans. EPO plans give you the option of seeing a specialist without a referral. However, EPO plans do not cover out-of-network physicians.
EPO plans typically have more expensive premiums than HMOs, but less expensive premiums than PPOs.