Plan Type Guide

HMO vs PPO vs EPO vs HDHP

Choosing the wrong plan type can cost you hundreds of dollars per month or leave you with unexpected bills. This guide explains each plan type, typical costs, and who each suits best.

HMOHealth Maintenance Organization

$328-380/mo

Average individual silver plan premium

Deductible

$2,000-5,000

Referrals

Required for specialists

Network

Must stay in-network

Out of Network

Not covered (emergencies only)

Pros

+Lowest monthly premiums
+Coordinated care through primary care doctor
+Lower out-of-pocket costs within network
+Predictable copays

Cons

-Must choose a primary care physician (PCP)
-Specialist referrals required
-No out-of-network coverage except emergencies
-Least flexible for travel or specialists

Best for: Budget-conscious individuals who live in one area, have a trusted primary care doctor, and rarely need specialist care.

PPOPreferred Provider Organization

$502-580/mo

Average individual silver plan premium

Deductible

$1,000-3,500

Referrals

Not required

Network

In-network preferred, out-of-network allowed

Out of Network

Covered at higher cost-sharing

Pros

+See any doctor without a referral
+Out-of-network coverage included
+Most flexible for travel and specialists
+No PCP required

Cons

-Highest monthly premiums
-Higher out-of-pocket costs
-Out-of-network costs can be substantial
-More complex billing

Best for: People who want maximum flexibility, see multiple specialists, travel frequently, or live in multiple states throughout the year.

EPOExclusive Provider Organization

$433-500/mo

Average individual silver plan premium

Deductible

$1,500-4,500

Referrals

Not required

Network

Must stay in-network

Out of Network

Not covered (emergencies only)

Pros

+No referrals needed for specialists
+Lower premiums than PPO
+Direct specialist access
+Simpler than PPO billing

Cons

-No out-of-network coverage except emergencies
-Smaller network than PPO
-Must verify all providers are in-network
-Limited if you travel frequently

Best for: People who want specialist flexibility without referrals but can live within a specific provider network.

HDHPHigh-Deductible Health Plan

$356-415/mo

Average individual silver plan premium

Deductible

$1,600-7,000+ (individual)

Referrals

Depends on plan design

Network

Depends on plan design

Out of Network

Depends on plan design

Pros

+Lowest monthly premiums
+HSA eligible - triple tax advantage
+Excellent for healthy, low-use individuals
+HSA funds roll over year to year

Cons

-High deductible before coverage kicks in
-Must fund HSA yourself
-Large unexpected bills if you get sick
-Requires financial discipline

Best for: Healthy individuals or families who rarely use healthcare, want to build an HSA, and can afford to pay the deductible if needed.

Quick Decision Guide

I want the lowest possible premium

HDHP if healthy, HMO if you use care regularly

I need to see multiple specialists

PPO for maximum flexibility, EPO if staying in-network is OK

I rarely go to the doctor

HDHP with an HSA - save on premiums and build tax-free savings

I have ongoing prescriptions or chronic conditions

Gold or Platinum PPO or HMO with low deductible

I live in multiple states or travel often

PPO - the only plan with reliable out-of-network coverage

I want tax-free savings for healthcare

HDHP paired with a Health Savings Account (HSA)