The difference comes down to two things: whether you need a referral, and whether out-of-network care is covered at all.

  • HMO keeps care inside its network and generally will not cover out-of-network care except in an emergency. Usually requires a primary care doctor and referrals. Typically the lowest premium.
  • PPO contracts with a network but lets you go outside it at a higher cost. No referral needed. Typically the highest premium.
  • EPO covers only in-network providers, like an HMO, but usually skips the referral requirement.
  • POS costs less in-network and does require a referral from your primary care doctor to see a specialist.

Before you choose, check the actual provider directory for your doctors and the drug formulary for your prescriptions. Network is where plans quietly differ most, and it is not visible in the premium.