HMO vs PPO vs EPO vs HDHP Calculator

Understanding Health Plan Types

When shopping for health insurance on the ACA marketplace, you'll encounter four main plan types. Each structures your costs, provider access, and care coordination differently. Here's what you need to know:

HMO (Health Maintenance Organization)

HMOs require you to choose a primary care physician (PCP) who coordinates all your care. You'll need referrals to see specialists, and out-of-network care is generally not covered except in emergencies. In exchange, HMOs typically offer lower premiums and predictable copays.

PPO (Preferred Provider Organization)

PPOs offer the most flexibility. You can see any doctor — in-network or out-of-network — without referrals. Out-of-network care costs more but is still partially covered. This flexibility comes with higher monthly premiums.

EPO (Exclusive Provider Organization)

EPOs combine elements of HMOs and PPOs. Like PPOs, you don't need referrals to see specialists. Like HMOs, you must stay in-network (except for emergencies). EPOs typically have moderate premiums — less than PPOs but sometimes slightly more than HMOs.

HDHP (High Deductible Health Plan)

HDHPs have the lowest premiums but highest deductibles. You pay full price for most services until meeting your deductible (minimum $1,650 individual / $3,300 family in 2026). The key advantage: HDHPs are the only plans that qualify you for a Health Savings Account (HSA), which offers triple tax benefits for medical expenses.

Which Plan Type Is Best?

There's no universally "best" plan type — it depends on your healthcare needs, budget, and preferences. Use the calculator above to get a personalized recommendation based on your specific situation.