Plan shopping would be a lot easier if the industry did not label everything in acronyms and then act as though you were born knowing them. You were not, nobody was, and this page fixes that. Every plan type really comes down to three questions: which doctors can I see, do I need permission slips, and how does the money work? Let us take the acronyms one at a time.
HMO: trading freedom for price
Network-only coverage with a referral to reach specialists. Least expensive, and a fine trade when your doctors are already in it.
A Health Maintenance Organization covers care from its own network of doctors and hospitals, and generally will not pay for care outside that network except in emergencies. You typically pick a primary care doctor, and getting to a specialist usually runs through a referral from them.
The trade is simple: less freedom, lower price. HMOs are often the least expensive plans on the shelf, and for a lot of people that is a perfectly good trade. It works best when your doctors are already in the network, or when you do not have strong doctor attachments yet.
The one non-negotiable: check the network before you buy, not after.
PPO: trading price for freedom
Covers out-of-network at a reduced rate with no referrals. More freedom, higher price, and scarce in some individual markets.
A Preferred Provider Organization covers both in-network and out-of-network care. In-network costs less, out-of-network is still covered at a reduced rate, and you generally do not need referrals to see specialists.
More freedom, higher price. One honest heads-up: in some individual markets PPOs are scarce or simply not offered, so the choice may get made for you. Where they exist, they fit people with established specialists, people who split time between states, and anyone who wants to go anywhere without asking first.
EPO: the in-between worth knowing
An HMO on networks, a PPO on referrals. Common in the individual market, so learn the label.
An Exclusive Provider Organization works like an HMO on networks, meaning no out-of-network coverage except emergencies, but more like a PPO on referrals, meaning you can usually book in-network specialists yourself.
These show up frequently in the individual market, so it is worth recognizing the label when you see it rather than assuming every non-PPO is an HMO.
HDHP: not a network type at all
Not a network type. It describes the money, and it is the only plan shape that unlocks an HSA.
Here is where people get tripped up. A High Deductible Health Plan can be an HMO, a PPO or an EPO underneath. What defines it is the shape of the money: a lower premium, a higher deductible you pay before most coverage begins, and preventive care still covered before the deductible.
The real headline is what an HDHP unlocks: a Health Savings Account. An HSA lets you set aside pre-tax money for medical costs. The money rolls over indefinitely, it stays yours if you change plans or jobs, and later in life it behaves more like an additional retirement account. For people who rarely use care, the HDHP and HSA combination often wins the total math even when the deductible looks frightening on paper.
One caution from experience: an HDHP with no savings behind it is a stressful plan. The deductible is real, and the HSA is the tool that makes it livable. Buy them as a pair, in spirit if not on paper.
What makes a plan an HDHP in 2026, and what you can put in the HSA
| Self-only | |
|---|---|
| Minimum deductible to qualify as an HDHP | $1,700 (family $3,400) |
| Maximum out-of-pocket the plan may have | $8,500 (family $17,000) |
| Most you can contribute to the HSA | $4,400 (family $8,750) |
Scroll the table sideways to see every column.
IRS figures for 2026, from Revenue Procedure 2025-19. They are indexed and change most years, so check the current year's numbers before relying on them. If you are 55 or older you can add a catch-up contribution on top.
How we would actually choose between them
Doctors first, then honest usage, then total cost. Premium math alone picks the wrong plan.
- Doctors first. List yours and check each plan's network by name. A plan type is irrelevant if your doctor is not in it.
- Count your care honestly. Lots of visits and prescriptions push toward richer plans. Rare usage pushes toward the HDHP and HSA route.
- Do total math, not premium math. Premium plus your realistic out-of-pocket spending. The cheapest premium loses that comparison surprisingly often, and so does the richest plan.
- Check the drug list separately. Two plans carrying the same acronym can treat the same prescription completely differently.
One last thing, because it is the part people only think about too late: whichever type you pick, know how to push back when a claim comes back denied. That is a process with real deadlines, and we walk it through in what to do when your claim is denied.