Quick answer
Neither is better for everyone. An HMO usually costs less but only covers in-network care and often requires referrals to see specialists. A PPO costs more but lets you see specialists without referrals and pays part of the cost for out-of-network care. Pick an HMO if your doctors are in its network and you want lower costs; pick a PPO if you need flexibility.
Key takeaways
- HMOs: lower premiums, in-network only, primary care doctor and referrals usually required.
- PPOs: higher premiums, out-of-network coverage, no referrals needed.
- Both must cover emergency care anywhere at in-network cost-sharing.
- EPO and POS plans fall in between.
- The right choice depends on your doctors, where you spend your time and your budget.
On this page
HMO vs. PPO at a glance
| HMO | PPO | |
|---|---|---|
| Premiums | Usually lower | Usually higher |
| Out-of-network care | Not covered except emergencies | Covered at a higher cost |
| Primary care doctor required | Usually | No |
| Referrals for specialists | Usually | No |
| Deductible | Sometimes low or none for some services | Usually, with a separate out-of-network deductible |
| Care away from home | Emergencies, sometimes urgent care | Often broader coverage |
When an HMO is the better choice
- Your doctors and hospital are in the HMO’s network.
- You want lower premiums and predictable copays.
- You don’t mind getting referrals, which can also help coordinate care, for example before an MRI.
- You mostly get care close to home.
More in HMO health plans.
When a PPO is the better choice
- You want to keep a doctor who isn’t in local HMO networks.
- You live part of the year in another state or travel often.
- You see several specialists and don’t want referrals.
- You’re willing to pay more for flexibility.
More in PPO health plans.
Other plan types to consider
- EPO (exclusive provider organization): in-network only like an HMO, but usually no referrals. See what is an EPO plan.
- POS (point of service): referrals like an HMO, with some out-of-network coverage like a PPO.
- High-deductible plans: can be any network type and pair with an HSA.
See health insurance coverage types for more.
How to decide
- Check whether your doctors are in each plan’s network.
- Compare the full-year cost: premiums plus the deductible and out-of-pocket maximum. If you’ll have more than one plan, see how deductibles work with two plans.
- Think about out-of-network risk. See what to do about out-of-network costs.
- Look at why prices differ; how health insurance rates are determined explains it.
Our guides to picking a health plan, comparing plans, discounts and the cheapest ways to get coverage go further.
Compare HMO and PPO plans near you: see quotes by ZIP code.
Frequently asked questions
Is an HMO or PPO better for a family?
If everyone’s doctors are in one HMO network, an HMO usually saves money. If family members see doctors in different systems or live apart, a PPO may work better.
Can I switch from an HMO to a PPO?
Yes, during open enrollment or after a qualifying life event.
Are HMOs lower quality?
No. Network type is about access and cost, not quality. Some of the highest-rated plans in the country are HMOs.
Why can’t I find a PPO on the marketplace?
Many insurers only sell HMO or EPO plans in the individual market. PPOs may be available off the exchange or through an employer.
Sources
This article is general information, not insurance advice. Plans vary, so compare the specific plans available to you. Last reviewed September 2026.