What Is a PPO? Health Plan Types Explained

Every health plan comes stamped with one of a handful of acronyms, PPO, HMO, EPO, POS, and most people enroll without ever quite knowing what the letters mean. Here's the plain-English version.

PPO (Preferred Provider Organization)

A PPO gives you the most flexibility. You can see any provider you'd like, in or out of network, usually without needing a referral to see a specialist. Staying in-network keeps your costs lower, but you're not locked out of going elsewhere. That flexibility usually comes with a higher monthly premium.

HMO (Health Maintenance Organization)

An HMO requires you to choose a primary care provider and stay within a defined network for your care. To see a specialist, you typically need a referral from your primary care provider first. In exchange for that structure, HMOs are usually more affordable than PPOs.

EPO (Exclusive Provider Organization)

An EPO is a middle ground. Like an HMO, you're limited to an in-network list of providers, care outside the network generally isn't covered except in an emergency. But like a PPO, you typically don't need a referral to see a specialist.

POS (Point of Service)

A POS plan is a hybrid of an HMO and a PPO. You'll usually choose a primary care provider and need referrals for specialists, similar to an HMO, but you also have the option to go out-of-network for care at a higher cost, similar to a PPO.

Quick comparison

• Want the most flexibility to see any provider? A PPO is usually the best fit.
• Want the lowest premium and don't mind a managed network? An HMO is usually the most affordable.
• Want no referrals but still want lower cost than a PPO? An EPO could be the sweet spot.
• Want a mix of both? A POS plan gives you some of each.