Health Insurance Learning Center
HMO vs PPO vs EPO: Which Plan Type Is Right for You?
HMO plans cost 15 to 20% less in premiums than PPOs but limit you to in-network providers. 73% of marketplace enrollees choose Silver plans (KFF). Here's how to pick the right combination.
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What Do the Metal Levels (Bronze, Silver, Gold, Platinum) Mean?
Metal levels determine how you and the insurance company share costs. They don't affect care quality. The 2026 out-of-pocket maximum is $9,200 individual / $18,400 family across all metal levels.
Bronze
Premium: Lowest
Deductible: Highest (~$7,000 to $9,200)
Healthy people who rarely use care and want low premiums
Silver
Premium: Moderate
Deductible: Moderate (~$3,000 to $5,000)
Most people - 73% of enrollees choose Silver (KFF). CSR benefits for lower incomes.
Gold
Premium: Higher
Deductible: Low (~$1,000 to $2,500)
People who use care regularly and want lower costs at the doctor
Platinum
Premium: Highest
Deductible: Lowest (~$0 to $500)
People with high healthcare needs who want predictable costs
What's the Difference Between HMO, PPO, and EPO?
Network type determines which doctors you can see, whether you need referrals, and how much flexibility you have. According to KFF's 2024 survey, PPOs are the most common employer plan type at 49% of covered workers.
| Feature | HMO | PPO | EPO |
|---|---|---|---|
| Out-of-Network Coverage | No (except emergencies) | Yes (at higher cost) | No (except emergencies) |
| Referral Required | Usually yes | No | No |
| Primary Care Doctor Required | Yes | No | Varies |
| Monthly Premium | Lower (15 to 20% less) | Highest | Moderate |
| Flexibility | Least | Most | Moderate |