Updated: July 19, 2026
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HMO and POS plans are not the same: HMO plans restrict all non-emergency care to in-network providers. POS plans let you go out of network for a higher cost and require you to file your own claims.
Both plan types require a primary care physician (PCP), a doctor who manages your care and refers you to specialists. The PCP requirement is what separates both HMO and POS from PPO plans.
POS Silver-tier plans averaged $692 per month for a 40-year-old in 2026 vs. $674 for HMO Silver-tier, per MoneyGeek's analysis. At Bronze tier, HMO averages $147 less per month than POS.
An HMO pays nothing when your preferred specialist is out of network. One out-of-network specialist bill can cost more than a full year of the premium difference between plan types.
HMO and POS plans both require a primary care physician who coordinates your care and specialist referrals for in-network visits. The difference that actually changes your bills is out-of-network access. POS plans cover out-of-network care at higher cost. HMO plans cover emergency visits only when you leave the network, under federal law.
That out-of-network access gap changes your provider choices, your paperwork and your financial exposure when care falls outside your contracted 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 | $692 |
Best for | Budget-focused, in-network care | Flexibility without full PPO cost |
At the Bronze tier, HMOs cost an average of $147 less per month. This gap narrows at the Silver tier, where POS plans average $18 more per month than HMOs. Most people assume greater flexibility always costs more, but the price difference varies wildly by tier.
An HMO, or Health Maintenance Organization, covers care through a contracted provider network. Every HMO plan requires you to choose a primary care physician, a doctor who manages your health, coordinates specialist visits and provides referrals.
If you see a doctor outside your HMO's contracted list then your plan pays nothing. Federal emergency law requires every health plan to cover emergency care regardless of network status, and that's the exception HMO plans make.
Blue Cross Blue Shield averaged $609 per month for HMO Silver-tier plans in 2026, per MoneyGeek's analysis. In my experience, buyers with established in-network relationships who rarely need out-of-area care get more value from an HMO than a POS.
A buyer who sees an out-of-network specialist for a non-emergency procedure gets the full bill. The plan pays nothing. That same appointment at an in-network facility costs a standard specialist copay. One out-of-network visit can eliminate the premium savings from a full year of lower monthly costs.
A POS plan, or Point of Service plan, combines features of HMO and PPO structures. The Centers for Medicare & Medicaid Services defines a POS plan as an HMO with an opt-out option: coordinated in-network care through a primary care physician and referrals, or out-of-network providers at higher cost.
A POS sits between HMO and PPO. You still have a PCP and still need referrals for in-network specialists. But you can go outside the network when you need to, at a higher price.
Ambetter's POS plans averaged $821 per month across all plan tiers in 2026, $125 below the national all-tier POS average per MoneyGeek's analysis. That spread shows how much POS pricing varies by insurer. Choosing a POS from the right carrier in your state often saves more than switching plan types entirely.
POS out-of-network access adds cost. A buyer who sees an out-of-network specialist pays a co-insurance rate, which is a share of the total bill rather than a flat dollar amount. Co-insurance applies after a separate out-of-network deductible. But the plan still covers part of the bill. An HMO pays nothing for the same visit.
HMO plans route all care through one network and one primary physician, which keeps costs predictable and removes most administrative work from the member. POS plans add out-of-network access, but that option raises your premium and creates a paperwork obligation, a separate deductible and self-filed claims for any visit outside the network.
The real trade-off isn't between features. It's between simplicity and access. Anthem's HMO plans averaged $683 per month in 2026, $13 below the national HMO average per MoneyGeek's analysis. That cost benchmark holds up well for buyers who plan to stay in-network.
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POS Silver-tier plans averaged $692 per month for a 40-year-old vs. $674 for HMO Silver-tier in 2026, per MoneyGeek's analysis. The more flexible plan type cost less at Silver tier, not more. In most states we reviewed, POS came in slightly below HMO at this tier.
Metal tier affects your premium far more than plan type does. POS Platinum averaged $1,252 per month vs. $349 for POS Expanded Bronze, a $903 gap driven entirely by tier. Tier choice matters at least as much as plan type.
POS | $692 | $661 | $755 | $1,252 |
HMO | $674 | $514 | $703 | $903 |
*Rates vary by state, age and insurer.
At Bronze tier HMO's cost $514 per month vs. $661 for POS Bronze, a $147 monthly difference. If you rarely use out-of-network care, an HMO at Bronze tier produces more savings than the Silver-tier comparison suggests. That's the recommendation for healthy buyers with established in-network providers. 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.
If every provider you rely on is in your plan's network, an HMO at Bronze or Silver tier is almost always the better value. The premium is lower, the claims process is simpler and there's no separate out-of-network deductible to account for. I've rarely seen a case where a buyer who stays in-network benefits from paying for POS flexibility they won't use.
POS plans are the better choice when you have a specialist, surgeon or care facility outside your preferred network. The out-of-network cost is higher per visit, but one avoided bill for a specialist outside your HMO coverage can offset months of the small premium difference. For buyers managing a chronic condition or planning elective surgery with specific providers, that backup coverage matters. 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… |
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HMO is the wrong choice if any of your preferred providers fall outside the plan's network. One out-of-network specialist bill under an HMO can cost more than a year of the premium difference between plan types.
POS is the wrong choice if you plan to stay in-network and want the lowest-cost, simplest claims structure. Paying for out-of-network access you won't use adds monthly cost without adding benefit.
Plan availability varies by county. Enter your ZIP code above to see which HMO and POS plans are available where you live before choosing a plan type.
The plan type is one decision. These are the factors that change the calculus for individual buyers, based on what we see buyers get wrong before they enroll. Work through each before comparing carriers or tiers.
Before choosing either plan type, confirm your current doctors are in the plan's network. Call each provider's office directly. Networks change annually, and a doctor listed as in-network at enrollment may not be in-network at renewal.
A provider who tells you they accept your insurance isn't necessarily in your HMO's specific plan network. Call the plan directly to confirm, not just the provider's office.
In my experience, this is the step most buyers skip and the one most likely to produce a surprise bill. A two-minute call before enrollment can prevent a claim dispute after.
Under an HMO, going out of network for non-emergency care means your plan pays nothing. Under a POS, you pay more but your plan covers part of the cost. Know which situation you're likely to encounter.
Both plan types require a referral from your PCP to see an in-network specialist. If you have a condition requiring frequent specialist visits, factor in the time to obtain a referral before each appointment.
HMO plans have your insurer process all claims. POS plans require you to self-file paperwork for any out-of-network visit. Self-filing delays reimbursement and adds administrative work after every out-of-network appointment.
HMO plans cover emergency care anywhere under federal law. Non-emergency out-of-network care outside your home area isn't covered at all. If you spend time in multiple states, POS out-of-network coverage becomes more valuable than the premium suggests.
Metal tier (Bronze, Silver, Gold, Platinum) affects your premium far more than plan type does. Decide which tier fits your health care usage first, then compare HMO vs. POS options within that tier.
At Silver tier, HMO ($674) costs $18 less than POS ($692). Tier choice moves your premium further than plan type does.
We've answered the most frequently asked questions about HMO vs. POS health insurance.
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.
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.
Yes. Under the Emergency Medical Treatment and Labor Act (EMTALA), enforced by the Department of Health and Human Services (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.
You can switch during the annual open enrollment period. For 2027 coverage, open enrollment runs Nov. 1, 2026, to Jan. 15, 2027, per CMS. A qualifying life event, includes 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.
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. $692 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 (P&C) Insurance Producer in Connecticut, is MoneyGeek's resident insurance expert. He has spent nearly a decade analyzing the market, first at LendingTree and now at MoneyGeek, where he produces original research on hundreds of carriers and millions of rates across auto, home, renters, health and life insurance.
He covers economics and insurance at MoneyGeek, and his work has been featured in The Washington Post, The New York Times and NPR, among other outlets.
Like all MoneyGeek analysts, he draws on independent cost and consumer experience data. No insurance company partnership influences his recommendations.
Mark holds a B.A. from Boston College and an M.A. in Economics and International Relations from Johns Hopkins University. He started his career in financial risk management at State Street and is also a five-time “Jeopardy!” champion.
