The seven main types of health plans are HMO, PPO, EPO, POS, HDHP, catastrophic and indemnity. The first four differ by network rules, while the others change how you share costs. In short, HMO and EPO plans usually cost less but keep you in network. PPO and POS plans, however, cover some care outside it.
- An HMO usually requires a primary care doctor and referrals, and it covers only in-network care except emergencies.
- A PPO lets you see specialists without referrals and also covers out-of-network care at a higher cost.
- In 2025, 46% of covered workers had a PPO and 33% had a high-deductible plan with a savings option, according to KFF.
- Only 14% of 2025 Marketplace plans were PPOs, so PPO choices are limited for many people who buy their own coverage.
- For 2027, an HSA-eligible plan needs a deductible of at least $1,750 for one person, and you can save up to $4,500 in an HSA.
Types of health plans at a glance
Every plan sits on two dials. First, the network type sets which doctors you can see and whether you need referrals. Second, the cost design sets how much you pay each month versus at the doctor's office. So HMO, PPO, EPO and POS describe the network, while HDHP and catastrophic plans describe the cost design.
That's why the two can overlap. For example, an HDHP can run on an HMO, EPO or PPO network. Indemnity plans are the odd one out, because they skip networks almost entirely.
What all ACA plan types include
Whatever the network, every Marketplace plan follows the same core rules. So before you compare health insurance plan types, know what stays the same:
- Ten essential health benefits, such as hospital stays, prescriptions and maternity care
- Preventive care like screenings and vaccines at no cost in network
- No denials or higher prices because of a pre-existing condition
- A yearly out-of-pocket cap on covered in-network care
- Emergency care, whether the hospital is in or out of network
New to these terms? Start with how premiums, deductibles and networks fit together. Then come back and pick the type that fits your doctors.
HMO and EPO plans: lower-cost networks
HMO and EPO plans both cover care only inside the plan's network, except in an emergency. In return, they usually carry lower premiums than PPOs. The big difference between them is referrals.
HMO: a primary doctor guides your care
A health maintenance organization (HMO) asks you to pick a primary care doctor. That doctor handles most of your care and sends referrals when you need a specialist. As a result, care stays coordinated, and claim paperwork stays light. However, an HMO generally won't pay for out-of-network care unless it's an emergency.
EPO: no referrals, but stay in network
An exclusive provider organization (EPO) works like an HMO with one key change. You can usually book an in-network specialist directly, without a referral. Still, the network rule is just as strict. So if you visit an out-of-network doctor for routine care, you pay the whole bill.
Want more detail? See how HMO and PPO networks differ, and read when an EPO or POS plan makes sense.
PPO and POS plans: more freedom to choose
PPO and POS plans both pay for some care outside the network. Because of that flexibility, they usually cost more each month than an HMO or EPO.
PPO: the widest choice
A preferred provider organization (PPO) lets you see any doctor, in or out of network, without a referral. You simply pay less when you stay in network. On the other hand, PPO premiums run higher. In addition, out-of-network doctors can bill you for the gap between their charge and what the plan pays.
POS: an HMO with a back door
A point of service (POS) plan blends the two styles. Like an HMO, it asks for a primary doctor and referrals to specialists. Unlike an HMO, though, it pays part of the bill when you go out of network. KFF found that 9% of workers with job-based coverage had a POS plan in 2025.
Out-of-network care is where budgets break. So before you count on that back door, read what you pay outside your plan's network.
Types of health plans comparison chart
Here's how all seven health insurance plan types stack up side by side. Premiums show typical patterns only, so real prices depend on your state, age and carrier.
| Plan type | Network | Referrals | Out-of-network care | Typical premium |
|---|---|---|---|---|
| HMO | In network only | Usually needed | Emergencies only | Lower than a PPO |
| PPO | Large network | Not needed | Covered at a higher cost | Highest of the four network types |
| EPO | In network only | Often not needed | Emergencies only | Lower than a PPO |
| POS | In network, plus some outside care | Needed for specialists | Partly covered | Between an HMO and a PPO |
| HDHP | Runs on any network type | Depends on the network | Depends on the network | Lower, but with a higher deductible |
| Catastrophic | Any network type | Depends on the network | Depends on the network | Low, but with a very high deductible |
| Indemnity | Almost any provider | Not needed | No network to leave | Varies by plan |
First, use the chart to narrow your list to two types. Then compare real plans in your ZIP code.
A licensed Vivna agent can check your doctors and drugs against HMO, EPO and PPO options in your area, at no cost to you.
HDHP, catastrophic and indemnity plans
These three kinds of health plans change how you pay, not just where you go. So think of them as cost designs that can sit on top of a network.
HDHP with an HSA
A high-deductible health plan (HDHP) trades a lower premium for a bigger deductible. In return, an HSA-eligible HDHP lets you open a health savings account. You put in pre-tax money, it grows tax-free, and then you spend it on care tax-free too.
Also, since 2026, all bronze and catastrophic plans on the Marketplace work with HSAs. That opens the door for many people who buy their own coverage.
Catastrophic plans
Catastrophic plans carry low premiums and very high deductibles. Even so, they cover at least three primary care visits a year before the deductible, plus preventive care. Normally, only people under 30 qualify. Others need a hardship or affordability exemption.
Starting with 2026 coverage, CMS also grants a hardship exemption to many people whose income falls below 100% or above 400% of the poverty line. Keep in mind that premium tax credits don't apply to catastrophic plans. So if you qualify for a credit, a bronze plan may cost you less.
Indemnity plans
A traditional indemnity plan, also called fee-for-service, lets you see almost any provider. You often pay the bill first, then file a claim, and the plan pays a share. Today these plans are rare. In fact, KFF found that less than 1% of covered workers had one in 2025.
Don't confuse them with fixed indemnity insurance. That product pays a set cash amount per day or visit, so it works as a supplement, not major medical. Our hospital and accident cash plans fill that role.
Know what isn't major medical
However, some products look like a health plan but skip ACA protections. For example, short-term plans can lower premiums for healthy people in approved states.
Short-term plans are not ACA-compliant. They can exclude pre-existing conditions, and they don't qualify for premium tax credits. Also, they're sold only in approved states.
Before you buy one, see how the alternatives to an ACA plan compare and our short-term coverage for approved states.
Cost vs flexibility across health insurance plan types
Most choices come down to one trade-off. More freedom to choose doctors usually means a higher premium. However, a bigger network only helps if you actually use it.
- All your doctors sit in one local network
- Specialist visits are rare for you
- Most of your care happens close to home
- Travel often or live in two states
- See several specialists each year
- Want to keep an out-of-network doctor
How big are the networks?
Network size also varies a lot. According to KFF data reported by RWJF, the average PPO enrollee could reach 53% of area doctors. By comparison, HMO and EPO enrollees could reach 37% and 38%.
Still, the right network is simply the one with your doctors in it. So look up each doctor with our network search links for every carrier. Then read how network size changes what you pay.
Which types of health plans are most common?
It depends on where you get coverage. For example, at work PPOs still lead. On the Marketplace, by contrast, PPOs are scarce.
Job-based coverage
KFF's 2025 Employer Health Benefits Survey shows how covered workers split by plan type:
If your job offers an HDHP, ask whether your employer adds money to your HSA. That deposit can tip the math in its favor.
Buying your own plan
On the individual market, the picture flips. RWJF found that only 14% of 2025 Marketplace plans were PPOs. In fact, 37% of U.S. residents live in a state with no Marketplace PPO at all. So many shoppers choose between HMO and EPO networks.
Each carrier also builds a different mix. For example, look at the plans Ambetter sells by state. Then shop ACA and private plans in your ZIP code.
How to choose among the types of health plans
Start with your doctors and your budget, then match your situation to a plan. This list is only a starting point, so confirm the details with a licensed agent.
Compare an HMO or EPO first.
Look at an EPO or PPO, so you can skip referrals.
A PPO usually travels best.
An HMO or POS builds that in.
Try an HDHP or an HSA-eligible bronze plan.
Compare catastrophic and bronze plans.
An HMO or EPO may cover them for less.
Steps before you enroll
- List your doctors and hospital
Search each one in the carrier's directory. Then call the office to confirm.
- Check your prescriptions
Find each drug on the plan's drug list, and note its tier.
- Price a full year
Add 12 months of premiums to the care you'll likely use. Then compare plans side by side.
- Get a second set of eyes
A licensed agent can double-check networks and drug lists for you.
Ask for the network name, not just the carrier. One carrier can sell an HMO and an EPO with different doctor lists in the same county. So we always search your doctors in the exact network on the plan you're about to pick.
Pick the network first, then the price.The rule our licensed agents repeat most
Plan type is only half the decision. Next, weigh how each metal level splits costs, and see how to match a plan to your situation. Or call a licensed Vivna agent at 888-730-6001.
Types of health plans: FAQs
What are the 7 types of health plans?
The seven common types are HMO, PPO, EPO, POS, HDHP, catastrophic and indemnity. The first four describe network rules, such as referrals and out-of-network coverage. HDHP and catastrophic plans describe cost design, so they can run on any network. Finally, indemnity plans skip networks and pay a share of nearly any provider's bill.
Which of the types of health plans is cheapest?
For monthly premiums, HMO and EPO plans usually cost the least among network types. Catastrophic and high-deductible plans can cost even less each month. However, they shift more cost to you when you need care. So compare the full yearly cost, including the deductible, not just the premium.
What is the difference between HMO, PPO, EPO and POS?
It comes down to referrals and out-of-network coverage. An HMO needs referrals and covers only in-network care. An EPO also stays in network but usually skips referrals. Meanwhile, a POS plan needs referrals but covers some outside care. Finally, a PPO skips referrals and covers outside care, at a higher premium.
Can an HDHP also be an HMO or PPO?
Yes. An HDHP describes the deductible, not the network. So an insurer can build an HDHP on an HMO, EPO or PPO network. For 2027, an HSA-eligible plan needs a deductible of at least $1,750 for one person or $3,500 for a family. Also, out-of-pocket costs can't top $8,700 for one person.
Which plan types work best for families?
There's no single answer. Families whose pediatrician and hospital sit in one local network often save with an HMO or EPO. On the other hand, families with a child in college out of state, or with several specialists, may prefer a PPO. Either way, check every family member's doctors before you enroll.
Can an agent help me compare plan types?
Yes. A licensed agent compares networks, drug lists and total costs across carriers for you. At Vivna, our agents work with 50+ carriers, and our help costs you nothing because carriers pay us. Plus, plan prices stay the same whether you buy through us or directly.
Vivna's licensed agents compare plans from 50+ carriers. Call Monday through Friday, 9am to 6pm.
Sources
- KFF: 2025 Employer Health Benefits Survey
- RWJF: Preferred provider organizations remain rare in the individual market
- IRS: Revenue Procedure 2026-24 (2027 HSA and HDHP amounts)
- HealthCare.gov: Health plan categories
- HealthCare.gov: Catastrophic health plans
- CMS: Consumers gain access to catastrophic plans for 2026
Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. Plan availability, networks and benefits vary by state and change over time. Short-term plans are available only in approved states and are not ACA-compliant coverage.