Types of Health Insurance Plans: Differences, Pros & Cons (2025)

HMOs cost less but have limits on which doctors you can see. You have to select a primary care doctor who coordinates everything and provides specialist referrals. Emergency care gets covered anywhere, but routine out-of-network visits come entirely out of your pocket. Your doctor options are pretty limited.

PPOs let you see specialists without referrals and visit out-of-network providers for partial coverage, though you'll pay more and handle extra paperwork. You get the widest provider access but pay higher premiums. 

You should choose a PPO as your health plan if you travel frequently, live in multiple states, or have specialists you don't want to give up.

EPOs offer larger networks than HMOs without requiring referrals for specialists. You must stay in-network except for emergencies, but you can see cardiologists or dermatologists directly. EPOs work well when your preferred doctors participate and you want specialist access without PPO costs.

POS plans combine HMO referrals with PPO out-of-network options, but get complicated quickly. You'll pay the least with referrals, more without them, and the most outside the network. Think about buying a POS if you want out-of-network backup and are usually okay with referral requirements.

You are eligible for Medicaid when your income is less than the established limits. Your eligibility depends on the state you live in, as rules change by state, but some states have expanded it to include people earning up to 138% of the federal poverty level, while others maintain stricter requirements.

Medicare covers people who are 65 and older or you can qualify if you have disabilities or kidney disease, which can vary for your specific condition. Part A handles hospital bills (usually free), Part B covers doctor visits (monthly premiums), and Part D adds prescriptions.  

Part C or Medicare Advantage plans bundle everything. Medicare-approved private companies offer these, often including extra benefits.

These plans require you to pay a minimum of $1,650 for a single person or $3,300 for families in deductibles before insurance cover starts. The payoff comes from pairing these plans along with Health Savings Accounts, which help you save pre-tax dollars for medical bills. You can roll over your HSA funds each year.

These plans cover what your primary health insurance does not, as you can buy additional plans such as dental care, vision services, critical illness, or extended hospital stays. These policies also pay cash benefits directly to you or your providers, which can help cover your expenses your main insurance won't touch. 

This doesn't replace comprehensive health coverage and has benefit limits and exclusions.

Short-term plans provide temporary cover for up to a year but usually do not include benefits like prescriptions, mental health services, and maternity care. 

Since no law binds them, companies can refuse coverage or charge more based on your health history. These plans also don't meet ACA requirements and may leave coverage gaps for essential health benefits.

Health sharing plans aren't insurance and provide no legal coverage guarantee. Faith-based organizations pool contributions to help pay medical bills, but you have zero protection if they fail or deny requests. Many exclude pre-existing conditions and require specific beliefs. 

State insurance departments don't regulate these; they may have tax implications and offer no legal recourse if the organization fails.

COBRA lets you keep employer benefits temporarily after job loss, divorce, or aging out of parents' plans. Depending on your circumstances, you'll pay full premiums plus 2% fees, lasting 18-36 months. Choose COBRA between jobs when you want to keep your current doctors and can afford the high temporary costs. 

You must elect COBRA within 60 days of qualifying events or lose coverage permanently, but coverage can be retroactive to your loss date if you pay premiums.

Few insurers offer indemnity plans today, making them nearly obsolete. These plans let you see any doctor without networks or referrals, but you pay upfront and wait for partial reimbursement based on "usual and customary" charges. Premiums cost significantly more due to no provider discounts. 

Reimbursement is limited to "usual and customary" charges, and you may face balance billing.