What is an HMO?
An HMO (Health Maintenance Organization) routes all your care through a Primary Care Physician (PCP) who coordinates referrals to specialists. In exchange for accepting that structure, you get the lowest premiums, the lowest copays, and the most predictable annual cost of any plan type. The catch: care outside the HMO network is generally not covered except in emergencies. HMOs work best for households that use care regularly, live in one region, and value predictable spending over provider flexibility. See the full comparison in our HMO vs PPO vs HDHP guide.
What is a PPO?
A PPO (Preferred Provider Organization) is the flexibility plan. You can see any licensed provider — in or out of network — without a referral. In-network care is cheapest, but out-of-network care is still partially covered, which matters when a specialist your PCP doesn't know is the right fit or when you travel. Premiums are the highest of the major structures because you're paying for optionality. PPOs are the default recommendation for families with established specialist relationships, professionals who travel, and anyone splitting time between multiple states.
What is an EPO?
An EPO (Exclusive Provider Organization) is a hybrid: PPO-style access — no PCP required, no referrals to specialists — combined with HMO-style network discipline. Coverage is limited to the plan's contracted network, with no out-of-network benefits except emergencies. Premiums typically land between an HMO and a PPO. EPOs work well for people who want the freedom of a PPO but live in a metropolitan area with a strong in-network provider list and don't travel often for care.
What is a POS plan?
A POS (Point-of-Service) plan is the reverse hybrid: HMO-style structure — you pick a PCP who coordinates care — combined with PPO-style out-of-network access. You need referrals for in-network specialists but can see out-of-network providers with reduced coverage and higher out-of-pocket costs. POS plans are less common than they used to be but still appear in certain markets. They suit families who want the coordination of an HMO but insist on the ability to reach outside the network if needed.
What is an HDHP?
An HDHP (High-Deductible Health Plan) has the lowest monthly premium of any structure but a deductible that meets IRS minimums — roughly $1,650 self-only and $3,300 family for the 2026 plan year, with higher out-of-pocket maximums. You pay for most non-preventive care yourself until you hit the deductible, at which point cost-sharing kicks in. Preventive care remains fully covered from day one. Most HDHPs are HSA-eligible, unlocking a triple-tax-advantaged savings account for medical expenses. HDHPs are the strongest long-term financial choice for healthy households and higher earners.
What is a catastrophic plan?
Catastrophic plans are a narrow category open to buyers under age 30 or those with a hardship or affordability exemption. They cover the essential health benefits but with very low premiums and very high deductibles — designed as protection against a worst-case medical event rather than routine care. They cover three primary care visits per year before the deductible and are ACA-compliant, but they do not qualify for premium tax credits. For a young, healthy buyer with tight cash flow, they can be a reasonable option — but an HDHP with HSA is usually a better long-term deal when eligible.
What is a short-term plan?
Short-term plans are a separate product outside the ACA framework. They are typically cheaper on paper, available year-round, and useful as a bridge — between jobs, waiting for a Special Enrollment Period, or before Medicare eligibility. The trade-offs are significant: they can deny coverage for pre-existing conditions, exclude essential benefits like maternity and mental health, impose annual and lifetime limits, and vary widely in quality. Treat short-term plans as temporary catastrophic protection, not a long-term replacement for ACA coverage.
Side-by-side comparison
| Plan type | Premium | Deductible | Referrals | Out-of-network | HSA eligible |
|---|---|---|---|---|---|
| HMO | Low | Low–med | Yes | No | No |
| PPO | Highest | Medium | No | Partial | No |
| EPO | Medium | Medium | No | No | No |
| POS | Medium | Medium | Yes | Partial | No |
| HDHP | Lowest | High | Varies | Usually no | Usually yes |
| Catastrophic | Very low | Very high | Varies | No | No |
| Short-term | Very low | Varies | No | Varies | No |
Figures reflect the 2026 plan year and vary by state, ZIP, age, and carrier. Check HealthCare.gov for current figures.
Which one should you pick?
Match the structure to the way you actually use care. If you use care regularly and want predictable costs, an HMO or POS plan usually wins. If you value flexibility and want to keep specific providers, a PPO or EPO makes sense. If you're healthy and want the lowest premium plus tax-advantaged savings, an HDHP with HSA is hard to beat. If you're under 30 and healthy on a tight budget, a catastrophic plan is a defensible fallback. If you need short-term coverage between other plans, a short-term plan bridges the gap — but plan the exit before you enroll.
Our 90-second quiz asks the four questions that actually matter — utilization, budget, household, and provider preferences — and returns a plan-type recommendation you can bring to a licensed advisor.
Frequently asked questions
What is the most common type of health plan?
PPOs and HMOs together dominate the individual market. HDHPs paired with HSAs are the fastest-growing category among younger and higher-income households.
Are catastrophic plans a good deal?
Only for eligible buyers under 30 or those with a hardship exemption. They protect against worst-case scenarios but offer very little routine coverage and do not qualify for subsidies.
Are short-term plans real insurance?
They are insurance, but not ACA-compliant. Useful as a bridge between plans; not a long-term substitute for comprehensive coverage.
What's the difference between an EPO and a PPO?
An EPO offers PPO-style access (no referrals, direct specialist visits) but no out-of-network coverage. Premiums typically sit between an HMO and a PPO.