Types of Plans

Here are three common types of plans. The type of plan you buy will determine whether your care is covered only when you see a provider in the network or if you need to get a referral if you choose to see a provider outside your network. Some types of plans are:
  • Preferred Provider Organizations (PPOs): PPOs give you the choice of getting care from in-network or out-of-network providers. You pay less if you use providers that belong to the plan’s network. You’ll pay more if you use doctors, providers, and hospitals outside the network. You may have higher out-of-pocket costs for services. If you have a PPO plan, you can visit any doctor without getting a referral.
  • Point-of-Service (POS) Plans: POS plans let you get medical care from both in-network and out-of-network providers. If you have a POS plan, you’ll choose a primary doctor from a list of participating providers. Your primary doctor can refer you to other network providers when needed. If you want to visit an out-of-network provider, you’ll also need a referral and you may pay higher out-of-pocket costs.
  • Health Maintenance Organizations (HMOs): HMOs usually limit coverage to care from providers who work for or contract with the HMO. An HMO generally won’t cover or has limited coverage for out-of-network care except in an emergency. If you use a doctor or facility that isn’t in the HMO’s network, you may have to pay the full cost of the services you get. HMO members usually have a primary care doctor and must get referrals to see specialists.

When comparing plans on HealthCare.gov, the type of plan is listed immediately below the name of the plan. Look for the initials PPO, POS, or HMO.  If you have questions or need help understanding the different types of plans, you can contact Consumers for Affordable Health Care’s HelpLine at 1-800-965-7476.