Plan types side by side
| Feature | HMO | EPO | POS | PPO |
|---|---|---|---|---|
| Out-of-network care (non-emergency) | Not covered | Not covered | Covered at higher cost | Covered at higher cost |
| Referral needed for specialists | Usually | No | Usually | No |
| Primary care doctor required | Usually | Sometimes | Usually | No |
| Can be HSA-eligible | Yes, if it's a qualifying HDHP | Yes, if it's a qualifying HDHP | Yes, if it's a qualifying HDHP | Yes, if it's a qualifying HDHP |
| Typical premium | Lowest | Low–mid | Mid | Highest |
| Best for | Lowest cost, care close to home | No referrals, local network | Mostly in-network with an escape hatch | Travelers, specific out-of-area doctors |
Definitions follow common plan-type usage. Individual plans vary, so always read the plan's own summary of benefits.
What is the difference between a PPO and an EPO?
Both let you see specialists without a referral. The difference is out-of-network care: a PPO pays part of it, an EPO pays nothing except for emergencies. If every doctor you use is in the EPO's network, the EPO is often the better value. If you split time between states, a PPO health insurance plan is usually safer.
HSA-eligible plans: how they fit with PPO, HMO and EPO
“HSA plan” describes how the deductible works, not the network. Under IRS Publication 969, you can contribute to a health savings account (HSA) only if you're covered under a high deductible health plan (HDHP) on the first day of the month, have no other health coverage except what the IRS permits, aren't enrolled in Medicare, and can't be claimed as a dependent on someone else's tax return.
The IRS describes an HDHP as a plan with a higher annual deductible than typical health plans and a maximum limit on the deductible and out-of-pocket costs you pay for covered care. Publication 969 also explains how that limit works “if the plan uses a network of providers,” so an HDHP can be built on a network. In practice, that means an HSA-eligible plan can be a PPO, an HMO or an EPO, and the network rules in the table above still apply.
- HSA-eligible PPO: PPO flexibility, including some out-of-network coverage, with a qualifying high deductible. For example, Amerus Ultimate HSA is an HSA-qualified plan on the Cigna network with in- and out-of-network benefits.
- HSA-eligible HMO or EPO: in-network care only (except emergencies), paired with an HSA.
Read how an HSA works or HSA-eligible plans for individuals and families. A tax professional can confirm your own eligibility and contribution limit.
Fixed indemnity vs. major medical
| Feature | Major medical | Fixed indemnity |
|---|---|---|
| How it pays | A share of the actual bill after deductibles and copays | A set dollar amount per day or per service, whatever the bill |
How you apply for private plans
Many private and short-term plans use a short application, and you can apply any time of year. See private health insurance for how it works.
How to choose
- List your doctors and check them in each plan's directory.
- Decide whether you need out-of-network or out-of-state care.
- Compare the total yearly cost: premiums plus the deductible you'd realistically hit.
- Want to save pre-tax? Consider an HSA-eligible plan, such as Ameristead’s HSA 8500.
PPO vs HMO health insurance in one line
In PPO vs HMO health insurance, a PPO pays something out of network and needs no referrals, while an HMO usually covers only in-network care and may need referrals, typically for a lower premium.
Frequently asked questions
Is a PPO better than an HMO?
Not automatically. A PPO costs more for flexibility you may not need. If your doctors are all in an HMO's network and you don't mind referrals, the HMO is usually the better value.
Where can I find an individual PPO plan?
Private plans with national PPO networks, such as Ameristead on the Cigna PPO network, are available in many states, and you can apply year-round.
Can I have an HSA with a PPO?
Yes, if the PPO is a qualifying high-deductible health plan. The network type doesn't decide HSA eligibility; the deductible design does.
Can you have an HSA with an EPO plan?
Yes, if the EPO is a qualifying high-deductible health plan. Network type doesn't decide HSA eligibility; the deductible design does.
What is the difference between an EPO and an HMO?
Neither covers non-emergency out-of-network care. The main difference is referrals: an HMO usually requires a primary care doctor and referrals to see specialists, while an EPO usually doesn't. HMOs typically have the lowest premiums.
For a real-world PPO example, see Amerus Ultimate PPO on the Cigna PPO network.
For a closer look at one plan type, read what an EPO plan is.
Related guides
Health insurance guides by state
Deadlines, exchanges, average premiums and short-term plan rules differ by state. Popular state guides:
Sources (checked November 11, 2026)
- IRS — Guidance on new HSA tax benefits under the One, Big, Beautiful Bill (Notice 2026-05)
- IRS Publication 969, Health Savings Accounts
Plan availability and eligibility are determined by the carrier.