ACA health insurance
HMO, PPO or EPO? What ACA plan network types mean for your doctors
The network type tells you how much freedom you have. In an HMO you generally need a primary care doctor and referrals. In an EPO you generally stay in network without referrals. A PPO lets you go outside the network, usually at a higher cost.
The three, in brief
- HMO: stays in network, often with a primary care doctor who refers you to specialists.
- EPO: stays in network, usually without referrals to see specialists.
- PPO: lets you see out-of-network doctors, with higher cost, and often no referrals.
Check the doctors, not only the letters
Within one type, networks vary a lot between insurers. Look up your own doctors and hospital in the specific plan's network before choosing, and check again at renewal because networks change.
Have this ready when you call
- Your doctors' names and locations
- Your hospital
- Your medicine list
- Your ZIP code
Common questions
What if my doctor is out of network?
Depending on the plan, care may not be covered except in emergencies, or you may pay more. Check before you enroll.
Can I change plans if my doctor leaves a network?
Sometimes, if you qualify for a special enrollment period. Otherwise you usually wait for open enrollment.
Related answers
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Information on this site is educational and does not guarantee eligibility, enrollment, pricing, or availability. It is not a recommendation to buy any specific plan or policy.