PPO and HMO are network types. A network is the group of doctors, hospitals, and other providers a plan has a contract with. The type tells you how strict the plan is about using that network.
This guide covers the four types you will see on HealthCare.gov. You'll also learn how to spot a plan's type and what Florida's 2026 plans looked like. Then we cover where a private PPO fits.
The four network types, side by side
HealthCare.gov lists four plan types: HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), EPO (Exclusive Provider Organization), and POS (Point of Service). You may find any of them at each metal level, like Bronze or Silver.
| Type | Out of network | Specialist referral |
|---|---|---|
| HMO | Generally not covered, except emergencies | Often needed |
| PPO | Covered, but costs more | Not needed |
| EPO | Not covered, except emergencies | Check the plan |
| POS | Costs more | Needed |
An HMO may also require you to live or work in its service area. HealthCare.gov says HMOs often focus on prevention and wellness.
With a PPO, you pay less when you use providers in the network. You can use providers outside the network without a referral, but it costs more.
An EPO covers care only from doctors, specialists, and hospitals in its network, except in an emergency. A POS plan costs less in its network. It also requires a referral from your primary care doctor to see a specialist.
How to tell which type a plan is
On HealthCare.gov, the plan type is listed right below the plan's name. Look for the letters HMO, PPO, EPO, or POS. The type is also listed on each plan's Summary of Benefits and Coverage.
- Make a list of your doctors, hospitals, and pharmacies.
- Search each plan's provider directory for every person on the plan.
- Insurance companies may use different networks for different plans, so check each plan you compare.
- If you are not sure, call the insurance company and ask.
Don't stop at the type. Networks differ from plan to plan, even within one company. Read the plan details for referral rules too.
What Florida's 2026 HealthCare.gov plans looked like
CMS publishes data on every plan sold on HealthCare.gov. We counted Florida's individual health plans for 2026. Of 410 plans, 316 were HMOs. There were 45 EPOs, 35 POS plans, and 14 PPOs.
Only one insurance company offered the PPO plans in this data. What you can buy depends on your county. As of October 3, 2026, CMS has not posted its 2027 plan data, and plans can change each year. Check your own choices during open enrollment.
Florida uses HealthCare.gov. As of October 3, 2026, under current law, open enrollment for 2027 coverage runs November 1, 2026, to January 15, 2027. A court case about these dates is still on appeal, so check HealthCare.gov. See every date in our Florida open enrollment guide.
Emergencies and out-of-network bills
All Marketplace plans must cover emergency care. CMS says plans can't charge you more in copays or coinsurance for emergency care at an out-of-network hospital. They also can't make you get approval first. You may still owe your deductible.
Outside of emergencies, going out of network can cost a lot. With an HMO or EPO, the plan may not pay at all. With a PPO or POS plan, you usually pay a bigger share. An out-of-network provider may also bill you for the difference between its charge and what the plan allows. This is called balance billing.
Questions to ask before you choose
- Are my doctors and my nearest hospital in this plan's network?
- Do I see specialists often? Will I need a referral each time?
- Do I live, work, or travel in more than one area?
- What are the premium, deductible, and out-of-pocket limit?
- Would I ever want care outside the network, and what would it cost?
No network type fits everyone. Compare total costs, not just the type. For a rough first look at prices, try our Policy Pricing Calculator.
Where a private PPO fits
Some people look at a private PPO sold outside HealthCare.gov. It is not a Marketplace plan, and it may not follow all of the ACA's rules. Each plan has its own network, so check the directory before you count on a doctor.
Private plans are different from Marketplace plans. Some private plans ask health questions, and approval is not guaranteed. Some may not cover care for health problems you had before you enrolled. Marketplace plans must cover health problems you already had. They can't charge you more for them.
Premium tax credits only help pay for plans bought through the Marketplace. If you get little or no tax credit, see our page on nationwide private PPO health insurance. Check for a tax credit first.