HMOs, PPOs & Other Health Insurance
There are many kinds of health insurance. Each type has rules that you must follow to get care. This page tells you about common kinds of health plans.
Kinds of plans
Most Californians have an HMO, PPO, or EPO. Some Californians have a fee-for-service plan, but that is less common.
- An HMO (health maintenance organization) has a network. These are the doctors, hospitals, labs, and other providers in the plan. You must get your care from these providers.
- A PPO (preferred provider organization) also has a network. You usually have more choice of providers in a PPO.
- An EPO (exclusive provider organization) also has a network similar to an HMO. Similar to a PPO, you can usually go to a provider without a referral from your main doctor.
- Fee-for-service insurance (indemnity insurance) usually costs more than HMOs and PPOs, but it gives you the most choice of doctors. Usually, you pay part of each bill, and the doctor bills your insurance company for the rest.
High-deductible health plans
Some HMOs, PPOs, EPOs, and fee-for-service plans are high-deductible plans. High-deductible plans have lower premiums but higher deductibles, compared with typical health plans.
Group vs. individual plans
You may have an HMO, PPO, EPO, or fee-for-service plan through your job, or you may buy a plan on your own.
- If you have health coverage through a job or union, you have group coverage. Some group plans are self-insured and have special rules.
- If you buy health insurance on your own, not through a job or union, you have individual coverage.
- Under health care reform changes in 2014, individual coverage has more benefits and rights and is more like group coverage.
What is an HMO?
What is a PPO?
What is an EPO?
Finding health care