Health plan types: HMO, PPO, EPO, HDHP/HSA

The plan "type" describes which doctors you can see and whether you need referrals. It is separate from the metal tier, which describes how costs are shared.

HMO: Health Maintenance Organization

• You must use doctors and hospitals in the plan's network. Out-of-network care is generally not covered except emergencies.
• You usually pick a primary care physician (PCP) who gives referrals to specialists.
• Premiums are often lower.

Good for: people who want lower costs and don't mind staying in a network.

PPO: Preferred Provider Organization

• You can see in-network and out-of-network providers, though out-of-network costs more.
• Usually no referrals needed for specialists.
• Premiums are usually higher.

Good for: people who want flexibility, travel a lot, or want to keep specific doctors.

EPO: Exclusive Provider Organization

• Network-only like an HMO (except emergencies), but usually no referrals needed.
• Premiums are often between HMO and PPO.

Good for: people happy with the network who want to see specialists directly.

HDHP with HSA

• A High-Deductible Health Plan has a higher deductible and usually a lower premium. It can be built on any network type (HMO, PPO, or EPO).
• If the plan is HSA-eligible, you can open a Health Savings Account: contributions are tax-advantaged, the money rolls over every year, and it can pay for qualified medical expenses. The IRS sets yearly contribution limits.
• Preventive care is generally covered before you meet the deductible.

Good for: generally healthy people, or anyone who can save in an HSA to cover the deductible.

Side-by-side

These are general patterns. Individual plans vary, so read the plan's Summary of Benefits and Coverage (SBC).