HMO, EPO or PPO: which network types the Marketplace sells in 2026, and how private plans compare

Browse Health Plans team · Reviewed by a licensed health insurance advisor · Updated October 6, 2026

If you shop the Marketplace in 2026, you will most likely be choosing between HMOs and EPOs. Across the 30 states that use HealthCare.gov, about half of all plans are HMOs, about a quarter are EPOs, and only about one plan in ten is a PPO. In 11 of those states there is no Marketplace PPO for sale anywhere. Where a PPO is offered, it usually costs more than the cheapest HMO or EPO in the same county, sometimes several hundred dollars a month more, and a tax credit does not cover that gap. Private plans sold outside the Marketplace often use broader PPO-style networks, but they are medically underwritten, which changes who can buy them.

This guide counts every 2026 Marketplace plan by network type, state by state, shows what a PPO costs next to an HMO or EPO in seven large counties, and explains when a narrower network is a fine trade and when it is not. Every Marketplace figure comes from the official 2026 plan file (CMS QHP Landscape PY2026, snapshot August 4, 2026), and how we price explains the method.

The four network types in plain English

A plan's network type tells you which doctors and hospitals it pays for and whether you need permission to see a specialist. The labels come from the insurer's filing, and the details vary by plan, but the general pattern holds:

• HMO (health maintenance organization). You use doctors and hospitals in the plan's network. Care outside the network is generally not covered except in an emergency. Many HMOs ask you to pick a primary care doctor and get a referral before seeing a specialist.
• EPO (exclusive provider organization). Like an HMO, there is no out-of-network coverage except emergencies. Unlike many HMOs, an EPO usually lets you see an in-network specialist without a referral.
• POS (point of service). A hybrid. You typically have a primary care doctor and referrals like an HMO, but the plan pays something toward out-of-network care, usually at a higher cost to you.
• PPO (preferred provider organization). The plan pays for both in-network and out-of-network care, with lower costs in network. No referrals are needed. Some PPO networks reach across state lines.

Two rules apply no matter which type you pick. Emergency care must be covered at in-network cost sharing even at an out-of-network hospital, and every Marketplace plan covers the same essential health benefits and pre-existing conditions. The network type changes where you get routine and planned care, not what is covered.

What the 2026 Marketplace sells, by the numbers

We counted every non-catastrophic plan option in the 2026 plan file for the 30 HealthCare.gov states. Of 3,969 plan options, 2,077 are HMOs (52%), 1,073 are EPOs (27%), 417 are POS plans (11%) and 402 are PPOs (10%). The mix varies a lot from state to state:

• No Marketplace PPO anywhere in the state (11 states): Arizona, Indiana, Kansas, Mississippi, Missouri, New Hampshire, Ohio, Oregon, Tennessee, Texas and Utah. Arizona and Ohio sell only HMOs. Kansas, Missouri, Oregon and Tennessee sell only EPOs. Texas has 805 plan options, the most of any state, and all are HMO, EPO or POS.
• A PPO in only some counties (4 states): Iowa (PPO available in 7 of 99 counties), Wisconsin (15 of 72), Nebraska (34 of 93) and North Carolina (90 of 100).
• At least one PPO in every county (15 states): Alabama, Alaska, Arkansas, Delaware, Florida, Hawaii, Louisiana, Michigan, Montana, North Dakota, Oklahoma, South Carolina, South Dakota, West Virginia and Wyoming. Alaska's plans are all PPOs. Oklahoma has the most PPO options of any state, 121, more than its HMOs.

Even in states with PPOs, they are usually a small slice of what is on offer. In Florida, 14 of 408 plan options are PPOs; in Michigan it is 8 of 112. If a PPO matters to you, check that one is sold in your county before you plan around it. The price comparison tool shows each plan's network type next to its price for your ZIP code.

What a PPO costs next to an HMO or EPO

Here is the cheapest Bronze and cheapest Silver plan for each network type in seven large counties, for a single 40-year-old, non-tobacco, at full price before any tax credit. The plan count is the number of non-catastrophic Marketplace options of that type sold in the county.

Source: CMS QHP Landscape PY2026, snapshot August 4, 2026. Age-40 prices calculated from the county's age-21 premiums with the state's age curve.

Three patterns stand out. First, the PPO price gap ranges from small to very large. In Jefferson County, Alabama the cheapest PPO Bronze is only $31 a month more than the cheapest EPO Bronze. In Miami-Dade it is $615 a month more, and the cheapest PPO Silver costs $1,123 a month more than the cheapest HMO Silver. Second, the gap is not always in the PPO's disfavor. Oklahoma County is the exception in this group: its cheapest PPO is cheaper than its cheapest HMO at both Bronze and Silver, because several insurers there file their main plans as PPOs. Third, in counties like Harris County, Texas, there is no PPO to compare, so the choice is between HMO, EPO and POS plans.

Network labels also do not tell you how big a network is. A large HMO built around a major hospital system can include more local doctors than a small PPO. The label tells you the rules for out-of-network care; the provider directory tells you who is in it.

Why the tax credit does not cover a PPO upgrade

The premium tax credit is a fixed dollar amount. It is set by your income and the price of the second-lowest-cost Silver plan in your area, called the benchmark, and it stays the same whichever plan you buy. That means the full difference between a cheaper HMO and a pricier PPO comes out of your pocket.

Take a 40-year-old in Miami-Dade who qualifies for a credit. Whatever the credit is, choosing the cheapest PPO Silver over the cheapest HMO Silver adds $1,123 a month, or $13,476 a year, to what that person pays. At Bronze the difference is $615 a month, or $7,380 a year. In Wayne County, Michigan the same choice adds $257 a month at Silver and $145 a month at Bronze. For most households receiving a credit, the cheapest plan of each tier is an HMO or EPO, and choosing a PPO means paying the full premium difference yourself.

The same applies to cost-sharing reductions. If your income qualifies you for the extra help that lowers a Silver plan's deductible, it applies to any Silver plan you pick, including a PPO, but the premium difference is still yours. The Bronze, Silver or Gold guide walks through how cost-sharing help changes the tier choice, and the 400% cliff guide covers households earning too much for any credit.

When an HMO or EPO is a fine choice

For many people, a narrower network costs nothing in practice and saves a lot in premiums. An HMO or EPO typically works well when:

• Your current doctors and the hospital you would want are in the plan's network. Check the provider directory, then call the office to confirm they take that specific plan for 2026.
• You live and get care in one area most of the year.
• Your prescriptions are on the plan's drug list at a tier you can afford.
• You do not mind a referral step for specialists, or you pick an EPO that does not require one.

A PPO or POS plan is worth pricing when you split the year between two states, have a specialist or treatment center that only a PPO network includes, or have children at college in another state. Even then, compare the yearly cost: a PPO that costs $3,000 to $13,000 more a year may not pay off unless you would otherwise use out-of-network care regularly.

Where private plans fit

Private plans sold outside the Marketplace are where many people find PPO-style networks. They typically use broad networks that work across a wide area, and you can enroll any month of the year rather than waiting for Open Enrollment. For a healthy applicant, private plans often cost less than a full-price Marketplace plan, and the price comparison tool shows a private range next to the Marketplace plans for your age and ZIP code.

The trade-off matters. Private plans are medically underwritten: the application asks health questions, and the carrier can decline you, charge more, or exclude a condition. They are not ACA coverage, are not sold on HealthCare.gov, cannot be paid for with the tax credit, and are not required to cover every essential health benefit. If you have an ongoing condition, are pregnant or planning to be, or qualify for a meaningful tax credit, the Marketplace is usually the better answer, and it always accepts pre-existing conditions. A narrower Marketplace HMO with a credit often costs far less than any private plan. Private ranges on this site are starting points for healthy applicants, and nothing here is a promise of what you will pay.

A sensible order is to check which Marketplace network types are sold in your county, see whether your doctors are in the cheapest ones, price the credit, and only then look at a private PPO-style plan if you are healthy and above the credit range or need a broader network. The age-40 state-by-state guide has Bronze and benchmark prices for every state, and our advisors can walk through networks and prices with you at no cost.

Questions people ask

Sources: CMS QHP Landscape PY2026 Individual Medical file (data.healthcare.gov, snapshot August 4, 2026) for every Marketplace plan count, network type and premium; IRS Rev. Proc. 2025-25 for the credit rules; carrier rate tables used by our advisors for private ranges. Plan counts exclude catastrophic plans. Figures are monthly, non-tobacco, before any credit unless stated, and can change before Open Enrollment. Network labels come from insurer filings; always confirm a doctor's participation with the plan. Tax rules summarised here are general; confirm with your tax professional.