HMOs provide health care services through networks of doctors, hospitals, and other health care providers.

• You must choose a primary care physician (PCP). You will need a referral from them to make an appointment with other doctors or specialists in the network.
• You usually pay copays for in-network doctor visits, medicine, emergency visits, and hospital stays. You will not pay a deductible or coinsurance.
• HMOs usually don’t pay if you go to a doctor or hospital that is not in their network. They will pay for out-of-network providers in some situations, like emergencies or when care is not reasonably available in-network.
• A doctor or hospital in your network cannot bill you for any balance after the copay is met.

PPOs let you get health care services through both in-network and out-of-network health care providers.

• You usually do not need a referral from a primary care physician (PCP) to see other doctors or specialists.

• You usually will pay a deductible.

• When you use the PPO network, you usually pay a copay for services covered by your plan.

• You may also have to pay for part of the total cost (coinsurance).

• Unlike HMOs, PPOs will usually pay for out-of-network care. But you usually will pay more in coinsurance.

• In emergencies or when care is not reasonably available in-network, your cost for out-of-network providers should be the same as in-network.

EPOs have features of HMOs and PPOs, but generally have fewer providers in their network.

• You usually do not need a referral from a primary care physician (PCP) to see other doctors or specialists.

• You may pay copays or coinsurance for services covered by the EPO.

• Many EPO plans require you to meet a deductible before paying for services.

• In emergencies or when care is not reasonably available in-network, your cost for out-of-network providers should be the same as in-network.

• Otherwise, EPOs don’t pay if you go to a doctor or hospital that is not in-network. That means you’ll have to pay the full cost of your bill.

A POS plan is a combination of an HMO and a PPO. A POS plan is rarely sold as a standalone product. They are usually sold as a part of an HMO or PPO.

• You must choose a primary care physician (PCP). You will need a referral from them to make an appointment with other doctors or specialists in the network.

• A POS plan usually pays for more of the bill if you use in-network doctors and hospitals.

• You may also have to pay for part of the total cost (coinsurance).

• When you use the network, you must pay copays.

• Unlike an HMO, a POS plan usually pays for out-of-network care. They will pay more of the bill if you use in-network doctors and hospitals.

• In emergencies or when care is not reasonably available in-network, your cost for out-of-network providers should be the same as if they are in-network.