EPO (Exclusive Provider Organization) plans

Not covered, except in an emergency

If you see an out-of-network provider, you will pay the full cost of the service.

• For example, if you want to see an out-of-network cancer specialist, you will pay the full price of that care.

Not needed for most plans

Most plans don’t require a referral from your primary care doctor to see an in-network specialist, but some plans do. Call your insurance company if you aren’t sure.

Moderate premiums and deductibles

You will pay full price for out-of-network care.

PPO (Preferred Provider Organization) plans

Covered, but with an extra cost

You can see out-of-network providers but you’ll have to pay more out of your own pocket.

• For example, if you want to see an out-of-network cancer specialist, the PPO will pay some of the cost, but you will pay a larger share of the bill.

Not needed

You can use doctors and other providers in and out of the network without getting a referral.

Higher premiums and deductibles

You will generally pay less for out-of-network care compared to EPOs and HMOs.

HMO (Health Maintenance Organization) plans

Not covered, except in an emergency or when care is not available in the network

You must get approval before seeing an out-of-network provider.

• For example, if you want to see an out-of-network cancer specialist, an HMO will pay for this provider if you get approval.

Needed

You usually must get a referral from your primary care doctor to see a specialist. Call your insurance company if you aren’t sure.

Lower premiums and deductibles

You will generally pay more for out of network care compared to PPOs.

High Deductible Health Plans (HDHP)

Often covered, but with an extra cost

You might pay full price for out-of-network care, such as an out-of-network cancer specialist.

• For example, if you want to see an out-of-network cancer specialist, the HDHP will pay some of the cost, but you will pay a larger share of the bill. You will pay the full price until you reach your deductible.

May be needed

Review the plan information or call their customer service line to see if you need a referral.

Lower premiums but the deductibles are higher

You will pay more out-of-pocket for care. Some HDHPs include health savings accounts (HSAs) where you can save money to use for medical care tax free.