The plan type you pick affects your costs, which doctors you can see, and how you access care. Here's a clear breakdown — no insurance jargon.
Get Help Choosing the Right Plan →How it works: You pick a primary care physician (PCP). All care flows through them — you need a referral to see a specialist. Out-of-network care is not covered (except emergencies).
Best for: People who want lower premiums, don't see many specialists, and have a doctor they like who accepts HMO.
How it works: No primary care doctor required. See any in-network specialist without a referral. Out-of-network care is covered at a higher cost-share.
Best for: People who see multiple specialists, travel frequently, or want maximum flexibility — and can afford the higher premiums.
How it works: Like a PPO (no referrals needed) but with HMO-like network restrictions — out-of-network is not covered. A middle ground between the two.
Best for: People who want no referrals but are OK staying in a specific network and want lower premiums than a PPO.
How it works: Low monthly premium, but high deductible (min $1,650 individual / $3,300 family in 2026). Must meet deductible before coverage kicks in. Pairs with an HSA.
Best for: Healthy people who rarely need care and want to build an HSA. Not good for those with chronic conditions or frequent specialist visits.
| Feature | HMO | PPO | EPO | HDHP |
|---|---|---|---|---|
| Monthly premium | Lowest | Highest | Medium | Very Low |
| Deductible | Low–Medium | Medium | Medium | High ($1,650+) |
| Need referrals? | Yes | No | No | Depends |
| Out-of-network covered? | No (emergencies only) | Yes (higher cost) | No | Sometimes |
| Primary care required? | Yes | No | No | No |
| HSA eligible? | No | No | No | ✅ Yes |
| Best if you... | Want low premiums + rarely travel | See specialists often + travel | Want flexibility without referrals | Are healthy + want tax savings |
Our licensed brokers ask the right questions about your doctors, prescriptions, and budget — then recommend the best plan type and specific plan for your situation. Free.
Get a Free Plan Recommendation →For families with young children who see their pediatrician regularly and don't have complex specialist needs, an HMO is often the better value — lower premiums and predictable costs. Families with chronic conditions or frequent specialist visits often prefer PPO for the flexibility.
Generally no — HMOs require a referral from your primary care physician to see a specialist. The exception is certain specialists like OB-GYNs (self-referral is often allowed) and emergency care.
Yes — you must be enrolled in a qualified High Deductible Health Plan to contribute to a Health Savings Account. Once you have an HSA, contributions are tax-deductible, growth is tax-free, and medical expense withdrawals are tax-free.
The ACA marketplace primarily offers HMO and EPO plans in most states. PPO plans are less common on the marketplace but more available through private/off-exchange purchases. A broker can tell you which plan types are available in your county.