Different Types of Networks
Health Insurance Marketplace plans are offered through several types of provider networks: HMO, PPO, EPO, and POS. Each network type determines how you access care, which doctors you can see, and how much you’ll pay.
When shopping for Marketplace plans on HealthSherpa, you can easily filter your options by network type using the filters on the left side of the screen.
Network Types:
HMO (Health Maintenance Organization): Requires you to use doctors and hospitals within the plan's network, except in emergencies. A referral from your primary care doctor is needed to see a specialist.
PPO (Preferred Provider Organization): Offers lower costs when you use in-network providers, but allows you to go out-of-network for an additional fee. Referrals are not required.
EPO (Exclusive Provider Organization): These plans require the use of in-network providers, except in emergencies. You do not need a referral to see a specialist within the network.
POS (Point-of-Service) Plans: These plans offer lower costs when you receive care from doctors, hospitals, and other healthcare providers within the plan's network. While you have the option to seek care outside the network, this will incur an additional charge. A referral is needed from your primary care doctor before seeing a specialist
Need Help?
If you need assistance understanding or updating your information, our Consumer Advocate team can help. Call 855-772-2663, Monday–Friday, 6 a.m.–4 p.m. PT, or visit www.healthsherpa.com to log into your account and make updates.