HMO vs PPO vs EPO vs POS: How Plan Types Differ for ACA, Short-Term, and Supplemental Health Insurance

Overview

When choosing health insurance, the alphabet soup of plan types—HMO, PPO, EPO, and POS—can be confusing. Each plan type offers different levels of flexibility, costs, and rules for how you access care. Selecting the right one depends on your budget, preferred doctors, and how often you need medical services.

This article breaks down the differences between HMO, PPO, EPO, and POS health plans, explaining how they compare across ACA marketplace plans, short-term medical coverage, and supplemental health insurance, so you can make an informed decision.

Overview of Health Plan Types

Health Maintenance Organization (HMO)

• How it works: You are required to choose a primary care physician (PCP) who coordinates all your care. Referrals are usually needed to see specialists.
• Pros: Lower premiums and out-of-pocket costs, emphasis on preventive care.
• Cons: Must stay in-network for coverage (except emergencies).

How it applies:

• ACA plans: HMOs are the most common marketplace option, keeping costs down but limiting flexibility.
• Short-term medical: HMOs are rare; most short-term plans are PPO-based.
• Supplemental insurance: Not typically offered in an HMO format since these plans are designed to pay cash benefits regardless of the provider network.

Preferred Provider Organization (PPO)

• How it works: Offers more flexibility with a large provider network. You can see specialists without a referral.
• Pros: Out-of-network coverage is included (though at a higher cost). No referral required.
• Cons: Higher premiums and deductibles compared to HMOs.

How it applies:

• ACA plans: PPOs are less common due to higher premiums, but they appeal to those who want broad provider choice.
• Short-term medical: PPOs are the dominant structure, giving temporary coverage more flexibility.
• Supplemental insurance: Not structured as PPOs, but you can pair them with PPO primary coverage for broader protection.

Exclusive Provider Organization (EPO)

• How it works: Similar to an HMO, but referrals are usually not required. Coverage is limited to in-network providers (except emergencies).
• Pros: Lower costs than PPOs, more flexibility than HMOs.
• Cons: No out-of-network coverage except in emergencies.

How it applies:

• ACA plans: EPOs are a common middle-ground option on the marketplace, striking a balance between cost and flexibility.
• Short-term medical: Rarely offered as EPOs—PPO dominates instead.
• Supplemental insurance: Not structured this way since supplemental plans don’t rely on provider networks.

Point of Service (POS)

• How it works: Combines features of HMO and PPO. Requires a PCP and referrals but allows out-of-network care at a higher cost.
• Pros: More provider flexibility than HMO.
• Cons: More paperwork and higher costs if you go out-of-network.

How it applies:

• ACA plans: POS plans are available in some states, often appealing to people who want flexibility but don’t need a full PPO.
• Short-term medical: Not typically structured as POS.
• Supplemental insurance: Not network-based, so POS rules don’t apply.

HMO vs PPO vs EPO vs POS: Side-by-Side Comparison 

HMO vs PPO vs EPO vs POS: Common Issues & FAQs

Q: Which plan type is best if I travel often?
A: PPO or POS plans are better since they cover out-of-network care. Short-term medical PPOs may also suit frequent travelers who need temporary coverage.

Q: Do all plans cover preventive care?
A: Only ACA-compliant plans must cover preventive services at no cost in-network. Short-term and supplemental plans are not required to include preventive care.

Q: Are referrals always required?
A: Only for HMOs and POS plans. PPOs and EPOs generally do not require referrals.

Comparison: ACA Marketplace vs. Short-Term Medical vs. Supplemental Insurance

Actionable Steps to Choose the Right Plan

1. Evaluate your healthcare needs – Consider how often you see doctors, whether you need specialists, and if you take regular prescriptions.
2. Check provider networks – Essential for ACA plans. For short-term coverage, confirm network size. For supplemental insurance, check how benefits coordinate with your main plan.
3. Compare costs – Balance premiums with deductibles, copays, and coinsurance. ACA subsidies may lower premiums. Short-term plans may look cheaper but lack ACA protections.
   • Check your eligibility, regardless of your income, using our ACA Subsidy Calculator, to see your estimated subsidy rate or consider switching plans.
4. Consider lifestyle – If you travel frequently, a PPO or POS ACA plan may be worth the higher cost.
5. Review plan documents carefully – Look for referral requirements, coverage exclusions, and whether the plan is ACA-compliant.

Explore our recent guide on How to Choose the Best Health Insurance Plan in 2025.

Bottom Line

The choice between HMO, PPO, EPO, and POS depends on how much you value flexibility versus cost—and whether you’re shopping for ACA coverage, short-term medical insurance, or supplemental plans.

• ACA marketplace plans: HMOs and EPOs dominate due to affordability; PPOs and POS exist but may be pricier.
• Short-term medical plans: Usually PPO-based, offering flexibility but limited benefits.
• Supplemental plans: Not tied to HMO/PPO structures but can fill coverage gaps regardless of your main plan type.