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

Key Takeaways

Both HMO and POS plans require you to choose a primary care physician who coordinates your care.

POS plans allow out-of-network care at higher cost. HMO plans cover emergency care only outside the network.

POS Silver-tier plans average $661 per month for a 40-year-old vs. $674 for HMO Silver-tier, per MoneyGeek's 2026 data.

Choosing the wrong plan type can mean thousands in unexpected out-of-network bills or unnecessarily high premiums.

What Is an HMO Health Insurance Plan?

An HMO, or Health Maintenance Organization, covers care exclusively through a contracted provider network. Members must choose a primary care physician (PCP) who coordinates all care and provides specialist referrals. Per HealthCare.gov, HMO plans offer lower premiums in exchange for restricting coverage to in-network providers only.

HMO plans don't cover non-emergency out-of-network care; federal law mandates emergency coverage as the sole exception. This structure keeps premiums lower than most other plan types and works best for buyers with trusted in-network doctors who rarely need out-of-area care. Blue Cross Blue Shield averaged $609 per month for HMO Silver-tier plans in 2026, per MoneyGeek's analysis.

What Is a POS Health Insurance Plan?

A POS plan, or Point of Service plan, is a hybrid health insurance plan combining features of HMO and PPO plans. The Centers for Medicare & Medicaid Services 2026 Quality Rating System defines a POS plan as an HMO with an opt-out option: members receive coordinated in-network care through a primary care physician and referrals, or choose out-of-network providers at higher cost.

This hybrid structure positions POS plans between the lower cost of HMO plans and the full flexibility of PPO plans.

What Are the Main Differences Between HMO and POS Plans?

HMO and POS plans share two core requirements: a primary care physician and specialist referrals for in-network care. The main difference is out-of-network access. POS plans allow out-of-network care at higher cost; HMO plans restrict out-of-network coverage to federally mandated emergency care only. That structural gap changes your flexibility, your paperwork burden and your costs when you need care outside your contracted provider network.


Network restriction	In-network only	In-network and out-of-network
PCP required	Yes	Yes
Referral required	Yes, for all specialists	Yes, for in-network specialists
Out-of-network coverage	Emergency care only	Yes, at higher cost-sharing
Claims filing	Insurer processes all claims	You file own claims for out-of-network visits
Deductible structure	Single in-network deductible	Separate in-network and out-of-network deductibles may apply
Avg. monthly premium (Silver, age 40)	$674	$661
Best for	Budget-focused, in-network care	Flexibility without full PPO cost

Pros and Cons of HMO and POS Plans

Costs stay predictable under an HMO, which routes all care through one network and one primary physician. POS plans add flexibility by covering out-of-network visits, but that option raises your premium and adds paperwork. Both plan types involve real trade-offs that depend on how often you need care outside your provider network and how much administrative work you're willing to do. Anthem's HMO plans average $683 per month, $13 below the national HMO average per MoneyGeek's 2026 analysis, a useful cost benchmark for buyers planning to stay in-network.


Pros	Lower monthly premiums than POS plans PCP coordinates all in-network care The insurer processes all claims directly Lower Bronze and Gold tier premiums Predictable copays and cost structure	Out-of-network care is covered PCP still coordinates in-network care Access to specialists outside your network Good middle ground between HMO and PPO costs Using referrals still gets lowest in-network rate
Cons	No out-of-network coverage except emergencies Referral required for every specialist visit Provider choice limited to plan network Out-of-area non-emergency care not covered Switching PCPs requires contacting insurer	Higher premiums than comparable HMO plans Must file own claims for out-of-network visits Separate out-of-network deductible may apply More complex cost structure than HMO plans Higher co-insurance for out-of-network visits

How Much Does an HMO Cost Compared to a POS?

POS Silver-tier plans average $661 per month for a 40-year-old vs. $674 for HMO Silver-tier (a $13 monthly difference), per MoneyGeek's 2026 analysis. Metal tier affects premiums far more than plan type: POS Platinum averages $1,252 per month vs. $349 for POS Expanded Bronze, a $903 gap driven entirely by tier. Choosing the right tier matters as much as choosing between HMO and POS.


POS	$661	$692	$755	$1,252
HMO	$674	$514	$703	$903

*Rates vary by state, age and insurer.

HMO costs less at Bronze and Gold tiers: HMO Bronze averages $514 per month vs. $692 for POS Bronze, a $178 gap. If you rarely use out-of-network care, an HMO at a lower tier usually produces the most savings. Families should factor in family deductibles and out-of-pocket maximums alongside premiums. Self-employed buyers can compare both plan types under marketplace tax credit scenarios.

How to Choose Between an HMO and a POS Plan

Your choice comes down to how often you need care outside your network. HMO plans work best if you have a trusted in-network PCP, rarely need out-of-area care and want the lowest monthly premium. POS plans suit buyers who want out-of-network access without full PPO costs. For seniors shopping for health insurance under 65, flexibility often matters more as specialist needs increase with age.

Choose an HMO Health Insurance Plan if…	Choose a POS Health Insurance Plan if…
You want the lowest possible monthly premium You have a trusted in-network primary care physician You rarely need out-of-area or out-of-network care You prefer your insurer to process all claims directly You're usually healthy and see doctors infrequently	You want out-of-network coverage as a backup option You see specialists who aren't always in-network You travel often and need flexible coverage You're comfortable filing out-of-network claims yourself You manage a condition requiring multiple providers

MONEYGEEK EXPERT TIP

If you rarely leave your network, an HMO at a Bronze or Silver-tier will almost always cost less than a POS at the same tier. If you travel frequently or see specialists who are occasionally out-of-network, a POS gives you that access without full PPO rates. Compare the best health insurance to review HMO, POS, PPO and EPO plans in your state before enrolling.

POS vs. HMO: FAQ

We've answered to the most frequently asked questions about HMO vs. POS health insurance.

Which is better, an HMO or a POS plan?

Neither is universally better. HMO plans cost less and suit buyers who stay in-network and want predictable bills. POS plans allow out-of-network care when you need it. Your choice depends on provider preferences, travel habits and whether your doctors fall outside the plan's network.

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

You can see an out-of-network specialist without a referral under a POS plan, but you'll pay out-of-network rates, meet a separate deductible and file your own claims. In-network specialist visits still require a referral from your PCP to access the lower cost-sharing rate.

Does a POS plan cover out-of-network emergency care?

Yes. Under EMTALA, enforced by HHS, all health plans (including HMO and POS plans) must cover emergency care regardless of network status. This federal protection applies to both plan types equally.

Can I switch from an HMO to a POS plan?

You can switch during the annual open enrollment period, which ran Nov. 1, 2025, to Jan. 15, 2026, for 2026 coverage per CMS. A qualifying life event (job loss, marriage, divorce or having a child) triggers a special enrollment period outside that window. Review all health insurance plan types before switching to confirm a POS plan fits your needs.

Is a POS plan the same as a PPO plan?

No. Both cover out-of-network care, but a PPO requires no PCP and no specialist referrals. A POS plan requires both. PPO Silver-tier plans average $789 per month for a 40-year-old vs. $661 for POS Silver-tier, per MoneyGeek's analysis. If you want out-of-network flexibility at a lower cost, a POS plan is the better option.

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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