What’s the difference between HMO, PPO, EPO, and POS networks?

HMOs usually require a primary care physician and referrals, and generally do not cover out-of-network care except emergencies. PPOs allow out-of-network coverage (often at higher cost) and typically don’t require referrals. EPOs are similar to HMOs but without referrals; they usually don’t cover out-of-network care beyond emergencies. POS plans blend HMO and PPO features and may require a PCP and referrals but include some out-of-network benefits.

Do PPOs always have nationwide access?

Not always. Many PPOs use regional or national networks, but access varies by carrier and product. Always verify your specific doctors and hospitals.

Will an HMO cover me when I travel?

HMOs typically cover emergencies out of area, but non-emergency care must be in-network and authorized. If you travel often, confirm how the plan treats away-from-home care.

What is prior authorization?

Prior authorization means the plan must approve certain services before you receive them. Without approval, the claim can be denied even if the provider is in network.

Robert Adams 9/5/25 Robert Adams 9/5/25

COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage

Quick guide to COBRA vs Marketplace vs Private PPO—costs, networks, and when each wins. We’ll verify your doctors and show clear prices.

COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage

Laid off, new job, or between jobs? Here’s the fast, practical guide—costs, networks, deadlines, and how to decide in minutes. We’ll verify your doctors and show clear costs.

COBRA (keep your old plan)

Same network/benefits you already know.
Usually most expensive (you pay full premium + 2%).
Time-limited (18 months); retroactive if elected on time.
Good when in treatment and changing plans is risky.

Marketplace (Government)

May be cheapest if your income qualifies for credits.
Many plans are HMO/EPO; referrals are common.
Mid-year move allowed due to loss of coverage.
Credits reconcile at tax time—under-reporting income can create payback.

Private PPO (Licensed Access)

Nationwide PPO when eligible; keep specialists/hospitals.
Typically no referrals; fewer hoops.
Advance premium tax credits do not apply to Private PPOs.
Pricing = age, ZIP, benefits, and network.
Great when you travel or want doctor choice.

What tends to cost more—and why

Why COBRA is often pricey

You pay the entire employer premium + 2% admin fee.
Large-group plan designs can carry higher OOP maxes.
No income-based help.

How non-Marketplace Private PPO prices

Based on age, ZIP, network size, and benefits.
Good fits: provider choice, travel, specialist access, fewer referrals.
We verify your doctors before you switch.

How to decide in minutes

Pick COBRA if…

You’re mid-treatment and can’t risk network changes.
You can stomach short-term higher premiums.
You need exactly the same plan and doctors right now.

Pick Private PPO if…

You want nationwide PPO and typically no referrals.
You travel, use specialists, or dislike gatekeepers.
Credits don’t help you—or you prefer not to use them.

We’ll compare all three with your doctors and meds, then show clear side-by-side costs.

Want the best post-employer fit in your ZIP?

We’ll verify your doctors and meds, compare COBRA vs Marketplace vs Private PPO, and show clear costs. No pressure—just answers.

Get Free Quotes Book a Call

FAQ

How long do I have to elect COBRA?

Generally 60 days from the notice. If elected in time, coverage can be retroactive to the loss date (you’d owe premiums).

Can I switch from COBRA to other coverage later?

Yes. Marketplace: during Open Enrollment (or another qualifying event). Private PPO: typically year-round if you’re eligible. We’ll time it so there are no gaps.

Do Private PPOs use ACA tax credits?

No. Private PPOs don’t use ACA advance premium tax credits (APTC). Marketplace plans do, and those credits reconcile at tax time—under-reporting income can create payback.

How do I know if my doctors are covered?

Send your provider list. We check your doctors against the specific plan network you choose so you know before you switch.

How do we start?

Share your doctors, prescriptions, and budget. We’ll map options and enroll you quickly and compliantly.

This overview is educational, not tax or legal advice. Availability varies by state and carrier. Eligibility and enrollment subject to plan terms.

Robert Adams 7/25/24 Robert Adams 7/25/24

Understanding Insurance Networks: A Key Component of Your Health Coverage

HMO, PPO, EPO, POS—your plan’s network determines which doctors you can see and what you’ll pay. Learn the key differences, when referrals apply, how out-of-network care works, and which network type best fits your doctors, prescriptions, and travel needs.

Understanding Health Insurance Networks: HMO vs PPO vs EPO vs POS | RKA

Guide • Networks & Access

Understanding Health Insurance Networks: HMO vs PPO vs EPO vs POS

Fast take: Your network determines where you can get care and what you’ll pay. If you have must-keep doctors, travel frequently, or want nationwide access, choose your network type first—then compare deductibles and copays.

The four common network types

HMO — “Stay in the circle”

Primary Care Physician (PCP) and referrals usually required.
No out-of-network coverage (except emergencies).
Often lower premiums; tight local networks.

PPO — “More flexibility”

No referrals needed to see specialists.
Out-of-network benefits (higher costs); national networks vary.
Good for travelers or multi-state families.

EPO — “HMO-like, no referrals”

Referrals typically not required.
Little to no out-of-network coverage beyond emergencies.
Popular on ACA Marketplace; check local access.

POS — “Hybrid”

PCP + referrals for in-network care.
Some out-of-network benefits at higher cost.
Useful when you want a PCP gatekeeper with flexibility.

Key rules to check before you enroll

Provider verification: Search by doctor name + NPI and confirm at the practice level.
Facility alignment: A doctor can be in network while their preferred hospital is not—verify both.
Prior authorization: Imaging, infusions, surgeries, and some meds may need pre-approval.
Rx formulary & tiers: Confirm your drugs, quantity limits, and preferred pharmacies.
Out-of-area care: If you travel or have college students away from home, read the away-from-home rules.

Which network should I choose?

Keep local doctors, low cost: HMO/EPO may work—verify providers and prior-auth rules.
Travel frequently / multi-state family: PPO or a plan with nationwide access is usually safer.
Want a coordinating PCP but some flexibility: POS can balance referrals with out-of-network options.

Quick FAQs

Are urgent care visits covered out of network?

Depends on the plan. Many HMOs/EPOs limit coverage to emergencies outside the service area. PPOs usually cover out-of-network urgent care at higher cost.

My doctor says they “take” my plan—am I safe?

Always verify with the plan’s directory and the office billing team. “We take it” can mean they’ll file a claim, not that they’re in network.

Can I change networks mid-year?

ACA plans generally change during Open Enrollment or with a qualifying life event. Some private options may allow year-round enrollment if eligible.

For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.