How to pick a health insurance plan

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Health insurance plan & network types: HMOs, PPOs, and more 3 things to know before you pick
a health insurance plan
The ‘metal’ categories: Bronze,
Silver, Gold & Platinum
Catastrophic health plans
Health insurance plan & network
types: HMOs, PPOs, and more
Your total costs for health care:
Premium, deductible & out-of-
pocket costs
There are different types of Marketplace health insurance plans designed to meet different
needs. Some types of plans restrict your provider choices or encourage you to get care
from the plan’s network of doctors, hospitals, pharmacies, and other medical service
providers. Others pay a greater share of costs for providers outside the plan’s network.
Types of Marketplace plans
Depending on how many plans are offered in your area, you may find plans of all or any of
these types at each metal level – Bronze, Silver, Gold, and Platinum.
Some examples of plan types you’ll find in the Marketplace:
Exclusive Provider Organization (EPO): A managed care plan where services are
covered only if you use doctors, specialists, or hospitals in the plan’s network (except
in an emergency).
Health Maintenance Organization (HMO): A type of health insurance plan that
usually limits coverage to care from doctors who work for or contract with the HMO.
It generally won’t cover out-of-network care except in an emergency. An HMO may
require you to live or work in its service area to be eligible for coverage. HMOs often
provide integrated care and focus on prevention and wellness.
Point of Service (POS): A type of plan where you pay less if you use doctors,
hospitals, and other health care providers that belong to the plan’s network. POS
plans require you to get a referral from your primary care doctor in order to see a
Preferred Provider Organization (PPO): A type of health plan where you pay less if
you use providers in the plan’s network. You can use doctors, hospitals, and providers
outside of the network without a referral for an additional cost.
Get more information on what you should know about provider networks (PDF).
Need dental coverage? Visit our Dental coverage in the Marketplace page
to learn more about options available to you.
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