HMO vs PPO vs EPO: Which Health Plan Type Fits Self-Employed Arizonans in 2027?

Quick answer: HMO plans usually cost less but keep you in a local network and often require referrals. EPO plans also cover only in-network care (except emergencies) but often skip referrals. PPO plans cost more but cover out-of-network care at a higher cost share, and some private PPO plans use nationwide networks. If you’re self-employed and mostly work around Phoenix, a Marketplace HMO or EPO, especially with a subsidy, is often the best value. If you travel, want specific specialists, or earn above the subsidy cliff, compare a PPO. Marketplace Open Enrollment for 2027 runs November 1, 2026 to January 15, 2027 (enroll by December 15 for a January 1 start).

Who this is for

1099 contractors and freelancers buying coverage on their own for the first time
Small business owners and solo consultants who travel for clients
Self-employed Arizonans comparing 2027 Marketplace plans during Open Enrollment
Anyone above the ACA subsidy cliff deciding whether a PPO is worth the higher premium

Why plan type matters more when you’re self-employed

When you work for a large employer, HR usually picks a short list of plans for you. When you’re self-employed, you’re choosing from the whole market on your own, and the plan type you pick decides which doctors you can see, whether you need referrals, and what happens when you get sick outside your home area.

Picking the wrong type is one of the most common and expensive mistakes we see. A cheaper HMO can look great until you need a specialist who isn’t in network, or until you’re working a job in another state and only emergency care is covered. Plan type also affects how far your premium dollar goes, which matters more now that 2027 premiums are rising sharply in Arizona.

HMO, EPO, PPO and POS in plain English

HealthCare.gov describes four main plan types you’ll see on the Marketplace. Here’s what each one means for you in practice.

HMO (Health Maintenance Organization)

An HMO usually limits coverage to doctors who work for or contract with the plan, and generally won’t pay for out-of-network care except in an emergency. You typically choose a primary care doctor who coordinates your care and refers you to specialists. An HMO may also require you to live or work in its service area.

EPO (Exclusive Provider Organization)

An EPO covers services only when you use doctors, specialists, or hospitals in the plan’s network, except in an emergency. Many EPOs let you see in-network specialists without a referral, which makes them a middle ground between an HMO and a PPO.

PPO (Preferred Provider Organization)

With a PPO, you pay less when you use in-network providers, but you still have some coverage when you go out of network. That flexibility usually comes with higher premiums. Some private PPO plans use national networks, which matters if you work in more than one state.

POS (Point of Service)

A POS plan is a hybrid. You pay less with in-network providers, you usually need a referral from your primary care doctor to see a specialist, and some out-of-network care may be covered at a higher cost.

HMO vs EPO vs PPO vs POS at a glance

Feature	HMO	EPO	PPO	POS
Out-of-network coverage	Emergencies only	Emergencies only	Yes, at a higher cost	Yes, at a higher cost
Referral to see a specialist	Usually required	Usually not required	Not required	Usually required
Monthly premium	Typically lowest	Typically low to moderate	Typically highest	Typically moderate
Network area	Local service area	Usually regional	Regional or nationwide	Regional
Best fit for	Budget-focused, stays local	Stays local, wants direct specialist access	Travels or wants specific providers	Wants a primary doctor plus some flexibility

Plan rules vary, so always confirm referral rules and out-of-network coverage in the plan’s Summary of Benefits and Coverage before you enroll.

5 questions to answer before you pick a plan type

Where do you actually work? If nearly all your work and care happen in the Valley, a local network may be all you need. If you take contracts in other states, an HMO or EPO usually covers only emergencies there.
Which doctors do you want to keep? Look up every doctor, specialist, and hospital you use in each plan’s directory, then confirm with the office.
Do you qualify for a subsidy? Premium tax credits can make a Marketplace HMO or EPO very affordable. Above roughly $62,600 for a single person (2026 coverage), there’s no subsidy, and the price gap between plan types matters more.
Do you want an HSA? HSA eligibility depends on the plan being a qualifying high-deductible plan, not on the network type. Private medically underwritten plans are not HSA-eligible.
How will you handle taxes? Self-employed people can usually deduct their premiums (see IRS Form 7206). That applies whichever plan type you choose.

Marketplace plans vs. private PPO plans

Your plan type choice also depends on where you buy. Marketplace plans and private medically underwritten plans follow different rules.

Feature	ACA Marketplace plan	Private medically underwritten plan
When you can enroll	Open Enrollment (Nov 1 – Jan 15) or a Special Enrollment Period	Year-round, any month
Health questions	None; you can’t be denied	Yes; approval depends on health
Pre-existing conditions	Always covered	May be excluded or limited
Subsidies	Available if income qualifies	Not available
Common network types	Often HMO or EPO; PPO availability varies by county	Often PPO, some with nationwide networks
HSA-eligible	Some qualifying high-deductible plans	No

Private plans are a complement to the Marketplace, not a replacement. If you have a health condition or qualify for a meaningful subsidy, a Marketplace plan is usually the right starting point. If you’re healthy, travel often, and pay full price, a private PPO is worth quoting. We break down that trade-off in more detail in our guide to PPO network access for high earners.

Real-world scenarios

A Mesa graphic designer who works from home

She earns about $48,000 a year from freelance clients and rarely leaves the Valley. She qualifies for a premium tax credit, so a Marketplace Silver HMO or EPO with her doctors in network is likely her best value. She should enroll by December 15 for a January 1 start.

A Scottsdale IT consultant who flies out every week

He earns well above the subsidy cliff and spends half the month at client sites in other states. An HMO would cover him mostly for emergencies on the road. A PPO with a broad or nationwide network, either on the Marketplace or a private plan if he qualifies on health, fits his life better.

A Tempe contractor managing an ongoing condition

He needs regular visits with a specific specialist. Because a private plan could limit coverage for his condition, he should stay on the Marketplace, where pre-existing conditions are always covered, and choose whichever plan type includes his specialist. If his only option with that specialist is an EPO, that’s still a better choice than a cheaper HMO without them.

Frequently asked questions

What is the difference between an HMO and a PPO?
An HMO usually limits coverage to doctors in its network, often asks you to pick a primary care doctor, and generally won’t cover out-of-network care except emergencies. A PPO lets you see out-of-network providers too, but you pay more when you do. PPOs typically have higher premiums in exchange for that flexibility.

Is an EPO the same as an HMO?
They are similar. Both generally cover only in-network care except in an emergency. The main practical difference is that many EPOs let you see in-network specialists without a referral, while HMOs often require one. Always check the plan documents, because the rules vary by plan.

Which plan type is best for self-employed people in Arizona?
It depends on how you work. If you stay in the Phoenix area and qualify for a subsidy, a Marketplace HMO or EPO is often the best value. If you travel for work, want specific out-of-network specialists, or earn above the subsidy cliff, a PPO is worth comparing.

Do HMO plans cover me when I travel outside Arizona?
Generally only for emergencies. An HMO may also require you to live or work in its service area. If you work in other states regularly, look for a plan with a broader or nationwide PPO network.

Can I deduct my health insurance premiums if I’m self-employed?
In most cases, yes. Self-employed people can generally deduct premiums for themselves, a spouse, and dependents if they aren’t eligible for an employer plan. The deduction doesn’t depend on whether the plan is an HMO, EPO, or PPO. Confirm the details with your tax professional.

Are PPO plans HSA-eligible?
HSA eligibility depends on whether the plan is a qualifying high-deductible health plan, not on the network type. Some Marketplace Bronze and Silver plans qualify. Private medically underwritten plans are not HSA-eligible.

Can I switch from an HMO to a PPO in the middle of the year?
On the Marketplace, you can usually change plans only during Open Enrollment (November 1 to January 15) or with a Special Enrollment Period. Private medically underwritten plans can be applied for any time of year, subject to health questions.

How do I know if my doctor is in a plan’s network?
Use the plan’s provider directory and then call your doctor’s office to confirm they accept that specific plan for the coming year. Networks change every year, so check again at each renewal.

Not sure which plan type fits how you work?

Tell me where you work, which doctors you want to keep, and your budget. I’ll compare HMO, EPO, and PPO options on the Marketplace, plus private plans if you qualify, and show you the trade-offs side by side. Free, no obligation.

Derek Greenlee, Greenlee Health Insurance
8687 East Vía de Ventura #210, Scottsdale, AZ 85258
Phone: 480-375-1652
Email: derek@greenleehealthinsurance.com
Website: greenleehealthinsurance.com

Book a free consultation →

Sources

HealthCare.gov — Health insurance plan & network types: HMOs, PPOs, and more
HealthCare.gov — Open Enrollment dates
HealthCare.gov — How insurance companies set health premiums
IRS — About Form 7206, Self-Employed Health Insurance Deduction
HealthInsurance.org — HMO, PPO, EPO, or POS: choosing a managed care option