There are different types of Marketplace health insurance plans designed to meet different needs. Some types of plans restrict your provider choices or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan’s network.
Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level – Bronze, Silver, Gold, and Platinum.
Some examples of plan types you’ll find in the Marketplace:
Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
Get more information on what you should know about provider networks (PDF).
To get details about any plan you’re interested in you can view a summary of benefits, a plan brochure, a provider directory, and a list of covered drugs. You’ll find links to all of these when you’re comparing Marketplace plans.
You’ll also find this information and can search by doctor or prescription drug when you compare plans and prices before you apply, and when you compare plans in the Marketplace. We’ve added new doctor and prescription drug lookup features, so you’ll see if your doctors or drugs are covered by your plan.
To be certain your doctor is included in your plan’s network, contact the plan or provider for the most up-to-date information.
Need dental coverage? Visit our Dental coverage in the Marketplace page to learn more about options available to you.