What are HMO, PPO, EPO and POS health insurance plans?

Understanding provider networks

If you have health insurance or are even just shopping for coverage, you have likely come across the term “network” or “provider network.” You may have seen acronyms like HMO, PPO, EPO or POS — but it may not be completely clear how choosing one over the other changes access to medical care and may affect out-of-pocket costs.

Which insurance is most affordable? Which health insurance plan is right for you? For a lot of people who get their health insurance through their employer, it comes down to what options are available if there's more than one choice. 

When you're considering which health plan to choose, here are some common questions you may want to ask:

What are provider networks?

A network can be made up of doctors, hospitals and other health care providers and facilities that have agreed to offer negotiated rates for services to insureds of certain medical insurance plans.

Why do health insurance companies provide access to networks?

To help keep costs down for both you, the customer using the medical insurance plan, and the insurance company itself. By negotiating rates for services, the insurance company can keep its costs down and may offer you lower out-of-pocket costs.

What are the different kinds of networks?

There are four basic kinds of networks you need to know: HMO, PPO, EPO and POS. It’s helpful to compare them in a few key categories.

Note: While we’re using common terms and definitions here, be aware that terms and definitions may vary by insurance company.

What network should you pick?

Everyone is looking for something slightly different out of their health insurance, so this is really a question you have to answer for yourself. But there are a few pointers you can keep in mind:

  • Before you start looking, make note of your “need to haves” and “want to haves” in terms of your provider network and benefits. Also, list any doctors or hospitals you want access to. Keep that information at hand while you shop.
  • Check the networks you’re considering for doctors, hospitals and pharmacies near to you before making any decisions, especially if easy access to care is important.
  • If your doctor’s already in-network, or you’re flexible about where you get care and can easily stay in-network, then choosing an HMO or EPO may mean a lower cost for you each month.
  • If you need the freedom to go outside a narrow network and still get some benefits from your coverage, then look at PPOs or a more flexible POS plan.

Need health coverage now?

Short term health insurance underwritten by Golden Rule Insurance Company may be just the fast, flexible solution you need for your temporary coverage. It provides access to large nationwide provider networks through UnitedHealthcare and coverage can be available as soon as the next day in many cases.

View short term health insurance plans