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What do the different networks mean (HMO, PPO, etc)?
What do the different networks mean (HMO, PPO, etc)?
Jess avatar
Written by Jess
Updated over a week ago

Summary: HMOs and PPOs are the most common. HMOs are often cheaper but require referrals from your primary care provider. PPOs don't require referrals and generally offer wider coverage, but you'll pay more for it.

Health insurance networks are groups of doctors and medical care providers who are under contract to treat patients with a certain insurance plan.

If you're seeing a doctor, for example, who is part of the network your plan covers, then that coverage is considered in-network, which is generally cheaper than out of network care.

When picking a network plan that works the best for you, it's crucial to keep your current health, finances, and resources in mind.

If you aren't sure which plan suits your needs, Catch has licensed insurance agents available and ready to help.

Which network type is right for me?

When it comes to different types of networks, it's an acronym salad. Here's a breakdown to clarify the differences.

There are four main types of health insurance networks:

  1. Health Maintenance Organization

  2. Preferred Provider Organization

  3. Exclusive Provider Organization

  4. Point of Service

These plans have different regulations regarding out-of-network care and the overall cost.

HMO (Health Maintenance Organization)

HMOs are plans that have their own network of doctors, hospitals, and other healthcare providers. People who enroll in these plans must receive care from an in-network provider, which may mean there are geographic constraints. These plans generally have lower premiums, but also have more restrictions around which providers you can see, and most referrals to see a specialist must come from a primary care physician (PCP). Out-of-network care is generally not covered unless it's an emergency.

Example: Cara lives and works in Tulsa, OK. She sees a primary care physician that is in-network with her HMO plan. When she needs to see a neurologist, she gets a referral from her primary care physician to see one who is in-network. 

PPO (Preferred Provider Organization)

PPOs also have a network of healthcare providers that offer services at a lower cost to members. The main difference is that out-of-network providers and care are usually still covered, just at a higher cost to members. In this way, PPOs allow users to choose the doctor or specialist they see and they do not require referrals from a primary care physician (PCP). Generally, premiums are higher for these plans to account for the freedom in choice.

Example: Jorge lives in Indianapolis, IN, but often takes jobs across the entire state of Indiana. In order to be sure his care is covered while he's traveling, he selected a PPO. When he gets sick and needs to see a specialist in Bloomington, he asks a friend for a recommendation and goes to see that specialist, who he pays a little bit more, but is still covered. 

EPO (Exclusive Provider Organization)

Similar to HMOs, EPOs have a specified network of doctors, hospitals, and other healthcare providers where members receive their care, and most out-of-network care is not covered unless it's an emergency. Like a PPO, though, members are able to see a specialist without a referral from a PCP.

Example: Justine lives and works in rural Nebraska, far from her PCP who she only sees once a year. This year, Justine decided she wants to start seeing a psychologist, who she would like to be able to start seeing without a referral from her PCP who she doesn't know very well.

POS (Point of Service Plan)

Like PPOs, POS plans have a network of healthcare providers where members can receive their care for the lowest cost. POS plans also allow members to receive care from out-of-network providers at a higher cost. Like an HMO, however, POS plans require referrals to specialists from a user's PCP.

Example: Chris lives in Austin, TX, but often travels to Houston for work. He rarely sees a doctor and doesn't expect to need to use his health insurance very often. Because he travels so frequently, though, he wants to make sure that if he gets sick or injured while traveling, he will be able to see a doctor that may not be in his network.

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