HMO (health maintenance organization) is a type of health insurance plan that usually limits coverage to care from providers who work for or contract with the HMO. HMOs require a primary care physician (PCP) as well as a referral from a PCP to access care from a specialist. These plans generally do not cover healthcare services accessed from out-of-network providers except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
PPO (preferred provider organization) is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. As a member of a PPO plan, you generally will not need to choose a primary care physician or receive a referral to see a specialist.
EPO (exclusive provider organization) is a managed care plan where services are covered only if you go to the doctors, specialists, or hospitals in the plan’s network (except in an emergency). Many EPO plans require that you select a primary care physician (PCP), but do not require a referral from your PCP in order to see a specialist.