What is the Difference Between an HMO, PPO, and EPO?

What are HMO, PPO, and EPO plans?

It can be difficult knowing how to choose the right health insurance plan. Before we compare HMOs, PPOs, and EPOs, see what each type of health plan offers.

HMO (Health Maintenance Organization)

An HMO is a coordinated‑care plan with a defined local network. 

Accessing care: Choose a primary care provider (PCP); referrals are required for most specialists.

Network requirements: In‑network only for routine care; emergency or urgent care covered anywhere.

Typical cost tendency: Lower premiums and predictable copays.

Pros: Lower monthly cost; coordinated care.

Cons: Lower flexibility; referrals required.

Best for: Members who are comfortable staying in‑network and looking for a lower-cost health plan.

PPO (Preferred Provider Organization)

A PPO is a flexible health plan with a broad network and out‑of‑network options.

Accessing care: No PCP or referrals required for Cigna Healthcare^® PPO plans.

Network requirements: In‑network care costs less; out‑of‑network is covered at higher cost; emergencies and urgent care covered anywhere.

Typical cost tendency: Higher premiums and cost sharing than HMO or EPO plans.

Pros: Maximum flexibility; travel‑friendly.

Cons: Higher monthly and out‑of‑pocket costs.

Best for: Members who need flexibility or use out‑of‑network providers.

EPO (Exclusive Provider Organization)

An EPO health plan offers in‑network‑only coverage without referral requirements.

Accessing care: No PCP requirement; see in-network specialists directly.

Network requirements: No out‑of‑network coverage except for emergencies.

Typical cost tendency: Lower than PPO; often higher than HMO.

Pros: No referrals required; more straightforward to access care than HMO.

Cons: No out-of-network benefits for non‑emergencies.

Best for: Members who want referral‑free access and are willing to stay in‑network.

At-a-Glance Comparison of Cigna Healthcare HMO, PPO, and EPO Plans

Details and coverage may vary depending on the health plan. 

Which health plan is right for me?

Choose an HMO if you...

• Want the lowest premiums, even if that means a higher deductible 
• Are comfortable choosing a PCP.
• Don’t mind referrals.
• Plan to stay in‑network.

Choose a PPO if you...

• Want maximum flexibility.
• Need out‑of‑network coverage.
• Are willing to pay higher premiums.

Choose an EPO if you...

• Don't want referrals.
• Are willing to stay in‑network.
• Want lower costs than a PPO.

HMO, PPO, and EPO Frequently Asked Questions

What’s the difference between in-network coverage and out-of-network coverage?

. When you visit an in-network doctor, you get in-network coverage and will have lower out-of-pocket costs. That’s because participating health care providers have agreed to charge lower fees, and plans typically cover a larger share of the charges.

If you choose to visit a doctor outside of the plan’s network, your out-of-pocket costs will typically be higher. Otherwise, your visit may not be covered.

How do I find out if my doctor is in the Cigna Healthcare plan’s network before I enroll?

It’s quick and easy to search for participating providers, specialists, pharmacies, hospitals, and facilities to match your needs.

If you're a current Cigna Healthcare member: log in to myCigna to quickly see in-network providers.

If you're not a member:

1. Visit the provider directory.
2. Choose how you're covered (Employer/School vs. Healthcare.gov)
3. Enter your search location and search by Type, Name, or Facilities.

Note: Just because a health care provider is listed in the directory doesn't mean that your health plan will cover all services. Look at your official plan documents, or call the number listed on your ID card, for information about the services your plan covers.

What if I need to be admitted to the hospital?

In an emergency¹, your care is covered. Requests for non-emergency hospital stays other than maternity stays must be approved in advance (also called prior authorization or pre-certification). This allows Cigna Healthcare to determine if the services are covered by your plan.

Prior authorization is not required for maternity stays of 48 hours for vaginal deliveries or 96 hours for caesarean sections. Depending on your plan, you may be eligible for additional coverage.

What counts as a "medical emergency"?

Emergency services are a type of care needed for sudden, serious conditions. In these cases, delaying treatment could seriously impact your health (for example, severe chest pain or uncontrolled bleeding). Under federal rules and Cigna Healthcare plan descriptions, emergency care is covered at in‑network benefit levels even if you receive it outside the network.¹

Who is responsible for getting prior authorization?

Your doctor will help you decide which procedures require hospital care and which can be handled on an outpatient basis.

If your doctor is in the Cigna Healthcare network, they will arrange for prior authorization. If you use an out-of-network doctor, you are responsible for making the arrangements. Your plan materials will identify which procedures require prior authorization.

What are the differences between HMO and PPO dental plans?

You can also get dental HMO and dental PPO plans. Learn more about the differences between DHMO and DPPO plans.