EPO vs. POS: Key Differences, Costs and How to Choose

Key Takeaways

For an average 40-year-old, EPO vs. POS Silver-tier premiums are close: $676 per month for EPO and $661 for POS.

Unlike EPO plans, POS plans cover out-of-network providers, though at a higher cost-sharing rate than in-network visits.

EPO plans don't require specialist referrals, but POS plans require a PCP referral to access any specialist at plan rates.

POS plans include an Expanded Bronze option at $349 per month, a metal tier EPO plans don't offer.

What Is an EPO Health Insurance Plan?

An Exclusive Provider Organization (EPO) is a health insurance plan that covers care only from providers within its network. EPO plans don't require a referral to see a specialist, and they're available on the Health Insurance Marketplace in Bronze, Silver, Gold and Platinum tiers, per HealthCare.gov's plan type definitions.

But EPO coverage stops at the network boundary for non-emergency care. If an EPO member sees an out-of-network provider, the plan pays nothing and the member covers the full cost. EPO plans work best for policyholders in areas with large, accessible provider networks.

What Is a POS Health Insurance Plan?

A Point of Service (POS) plan pairs the in-network structure of an HMO plan with limited out-of-network access. POS plans require policyholders to choose a primary care physician (PCP) who coordinates care and issues referrals for all specialist visits. Unlike an EPO plan, a POS plan covers some out-of-network care at a higher cost-sharing rate. POS plans also differ from PPO plans on premium cost and out-of-network billing structure.

Your PCP coordinates all specialist referrals, and staying in-network means paying the lowest co-insurance and copay rates.
POS plans cover out-of-network providers at a higher cost-sharing rate, with direct claim filing required.
POS plans offer an Expanded Bronze tier at $349 per month, the lowest option of the two.

How Do EPO and POS Plans Compare?

EPO and POS plans are two of the four main types of health insurance plans sold on the marketplace, but eight structural differences determine how much you pay out of pocket, how you access specialists and whether you can see providers outside the plan's network.


Network access	In-network only	In- and out-of-network
Out-of-network coverage	Emergency visits only	Yes, at higher cost-sharing
Referral required	No	Yes, from PCP
Primary care physician required	No	Yes
Monthly premium, Silver (age 40)	$676	$661
Monthly premium, Gold (age 40)	$732	$755
Expanded Bronze option	No	Yes ($349/month)
Claims process	Insurer handles all claims	May need to file out-of-network claims

What Are the Pros and Cons of EPO and POS Plans

EPO plans cost less at the Gold tier and don't require policyholders to manage a primary care physician relationship. But that cost advantage comes with one hard limit: EPO plans pay nothing for out-of-network non-emergency care, leaving members to cover the full bill out of pocket.

POS plans give policyholders out-of-network access and the Expanded Bronze tier at $349 per month, the lowest option between the two plan types. And that flexibility costs more at the standard Bronze tier, where POS plans are $191 more per month than EPO plans.


Pros	Lower Gold-tier premium ($732/month vs. $755/month) No referral required to book specialist appointments No primary care physician required Insurer handles all claims automatically Predictable costs for members who stay in-network	Out-of-network care covered at plan rates Expanded Bronze option at $349/month Lower Silver-tier premium ($661/month vs. $676/month) More protection for frequent travelers Out-of-state providers accessible at cost-sharing rates
Cons	No out-of-network coverage for non-emergency care No out-of-state coverage beyond medical emergencies Higher Silver-tier premium than POS ($676/month vs. $661/month) Less flexibility for policyholders with travel needs	PCP referral required to see any specialist Higher standard Bronze and Gold tier premiums Out-of-network claim filing required in some cases Primary care coordination adds a step to specialist access

How Much Does an EPO Cost Compared to a POS?

For an average 40-year-old, EPO plans cost $676 per month at the Silver tier and POS plans cost $661, per MoneyGeek's 2026 average health insurance cost data. POS plans also offer an Expanded Bronze option at $349 per month that EPO plans don't match. At the Gold tier, EPO plans cost $732 per month vs. $755 for POS. Both plan types are sold on the Health Insurance Marketplace across Bronze, Silver and Gold tiers.


EPO	$501	$676	$732
POS	$692	$661	$755

POS plans cost less at the Silver tier, where cost-sharing reductions apply exclusively for eligible marketplace enrollees. Those reductions aren't available on Bronze, Gold or Platinum plans regardless of plan type. Policyholders who qualify for Premium Tax Credits can apply those credits to EPO or POS plans at any metal tier.

Should You Choose an EPO or a POS?

EPO and POS plan selection depends on how often you need out-of-network care, whether you travel regularly and how much you want to pay per month.

An EPO plan works for policyholders in areas with large provider networks who want no referral requirement and lower Gold-tier premiums.

A POS plan works better for policyholders who travel often, have dependents out of state or want the lowest monthly premium. You can compare both plan types and check subsidy eligibility during the annual open enrollment period each fall.

Choose an EPO Health Insurance Plan if…	Choose a POS Health Insurance Plan if…
You live near a large in-network provider directory You want to see specialists without a referral You prefer lower Gold-tier premiums ($732 vs. $755/month) You prefer simpler billing with no out-of-network claims to file You rarely need care outside your local provider network	You want access to out-of-network providers when needed You travel often or have college-age dependents out of state You want the Expanded Bronze option at $349/month You're comfortable coordinating care through a primary care physician You live where in-network provider options are limited

POS vs. EPO: Bottom Line

EPO and POS plans are close in cost at the Silver tier but differ on network flexibility. EPO plans skip the PCP referral requirement and cost less at the Gold tier. POS plans cover out-of-network care and offer the Expanded Bronze tier at $349 per month. The right plan comes down to your local provider network and how often you need care outside it.

Frequently Asked Questions

We've answered the most frequently asked questions about EPO vs. POS insurance plans:

Is an EPO or POS plan better for someone who travels often?

A POS plan is the better fit for frequent travelers. POS plans cover out-of-network providers at a higher cost-sharing rate, so you don't pay full price for out-of-state care. EPO plans cover out-of-network care only in emergencies.

Can I see a specialist without a referral on a POS plan?

POS plans require a referral from your PCP to see any specialist. EPO plans don't require referrals, but all specialists must be in-network. For referral-free specialist access without a PCP, an EPO plan is the better choice.

What is the cheapest EPO or POS plan for a 40-year-old?

POS Expanded Bronze is the cheapest option at $349 per month for a 40-year-old, per MoneyGeek's 2026 data. EPO plans start at $501 per month at Bronze. At Silver, POS costs $661 per month vs. $676 for EPO.

About Mark Fitzpatrick

Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.

Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!

He writes about economics and insurance, breaking down complex topics so people know what they're buying.

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