HMO health insurance – everything you need to know

Shopping for health insurance plans can be complicated, and one of the key decisions you have to make is what type of insurance plan is best for your needs. The health insurance Marketplace offers a variety of plan types, including HMO plans, which are among the most popular. Read on to learn more about what HMO health insurance is and how it compares to some of the other choices out there.

What is HMO health insurance?

HMO stands for Health Maintenance Organization. With an HMO, you get access to medical providers and health care facilities within a network. You are covered by your health insurance plan as long as you stick to an in-network provider. If you go to an out-of-network doctor or hospital, you’ll have to cover your own expenses; the only exception is emergency situations.

Generally, with HMO health insurance, you’ll need to choose a primary care provider who can then refer you to specialists when needed.

What is PPO health insurance?

PPO stands for Preferred Provider Organization. As its name implies, you have more flexibility in choosing your preferred provider. PPO insurance plans have both in-network and out-of-network doctors and hospitals so you can choose the healthcare providers you want. If you stay in-network, you’ll pay less than if you go see an out-of-network provider.

Unlike an HMO, PPOs don’t require you to choose a primary care provider nor get a referral before seeing a specialist.

HMO vs. PPO – which is better?

While there are differences between a PPO and an HMO, both types of health insurance can be good choices. Ultimately, it depends on your healthcare needs and preferences.

If you like having one primary doctor taking care of and coordinating all your medical care, an HMO plan is better. If you require specialist visits and want to be able to go directly to them, a PPO plan is better. Those who travel often may also want to go with a PPO since you’ll be able to see doctors outside of your network, whereas with HMO health insurance you would have to cover all your expenses if you went to a healthcare provider outside of your network.

Another consideration is cost. HMOs are typically more affordable than PPOs. But remember that you will only be covered if your doctor is part of the HMO network, so double check first if you have a specific medical professional you like and want to keep going to. If they’re not part of the HMO network, enrolling in a PPO plan will still give you access to them.

While HMOs and PPOs are the main types of health insurance, there are also other choices such as EPO insurance and POS insurance.

What is EPO health insurance?

EPO stands for Exclusive Provider Organization. As its name implies, there is an exclusive network of medical professionals and facilities that are covered under this type of plan. You don’t need a primary care provider or referrals to see a specialist, but you also have to stay within the network. If you go to a doctor outside of the EPO network, you’ll have to pay for everything yourself.

HMO vs EPO – which is better?

In one sense, HMO plans and EMO plans are quite similar. Both have a particular network where you can seek medical care. However, an EPO is better for those who want more freedom to go to specialists without discussing it with a primary care provider first.

What is POS health insurance?

POS stands for Point of Service. With a POS plan, you’ll need to have a primary care provider who coordinates your medical needs. This primary care provider can refer you to both in-network and out-of-network doctors, though the latter typically costs more.

HMO vs POS – which is better?

A POS plan is like an expanded HMO. If you like the centralized care that an HMO offers but also want to be able to see out-of-network providers, you should consider a POS plan.

Have an idea of which type of plan fits your healthcare needs the best but also need to consider costs? You can compare plans and prices with HealthSherpa’s tool.


HealthSherpa is a free website and team of real people who can help you find, enroll in, and make the best use of your marketplace health insurance.

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