California small-business plan guide

HMO vs. PPO vs. EPO vs. HDHP

Compare how each plan type handles networks, referrals, out-of-network care, prescriptions, and employee cost before choosing a lineup.

Compare the plan types Estimate employee cost

Provider network
Care access
Annual cost

Start with the structure

Choose a plan type to see what changes.

These are general patterns—not guarantees. The exact carrier network, benefits, and plan documents always control.

HMO

Health Maintenance Organization

Coordinated care within a defined network.

Network

In-network care is generally required except for emergencies.

Access

A primary care physician and specialist referrals commonly apply.

Cost pattern

Often emphasizes predictable copays and a focused network.

May fit

Employees whose doctors and facilities participate in the exact HMO network.

Verify before enrolling

Primary care physician and medical group
Specialist referral rules
Service area and urgent-care access

At-a-glance comparison

See the four structures side by side.

Use the table to identify questions, then verify the exact plan rather than relying on the category name.

Compare	HMO	PPO	EPO	HDHP
Typical network approach	Network only	Network + possible out-of-network	Network only	Depends on underlying network
Primary care coordination	Commonly required	Usually not required	Varies by plan	Depends on underlying network
Specialist referrals	Commonly required	Usually not required	Often not required	Depends on underlying network
Non-emergency out-of-network care	Generally not covered	May be covered at higher cost	Generally not covered	Depends on underlying network
HSA eligibility	Only if specifically HSA-qualified	Only if specifically HSA-qualified	Only if specifically HSA-qualified	Confirm official HSA-qualified status

Swipe horizontally to compare all plan types.

Employee cost worksheet

Compare two plans beyond the monthly deduction.

Enter an employee’s monthly payroll deduction and a personal estimate of expected annual medical and prescription spending. Values stay in this browser.

Annual payroll cost+Expected care cost=Estimated annual amount

This worksheet is educational and cannot predict claims, covered services, negotiated prices, or final member responsibility.

Plan A Monthly payroll deduction$ Expected annual care and prescription cost$

Estimated annual amount$0

Plan B Monthly payroll deduction$ Expected annual care and prescription cost$

Estimated annual amount$0

Enter both plans to compare the estimates.

Plan comparison checklist

Verify the details that can change the decision.

Check each item as you compare the exact carrier plans. Print a clean copy for an employee meeting or renewal discussion.

01Exact plan and network name 02Doctors, specialists, hospitals, and medical groups 03Prescription formulary and preferred pharmacies 04Employee annual payroll contribution 05Deductible, copays, coinsurance, and out-of-pocket maximum 06Referral, out-of-network, travel, and HSA rules

Official sources

Confirm the exact rules at the source.

Official resources reviewed August 2026.

California employer guidance

Build a plan lineup employees can understand.

We can compare available carrier plans around your workforce, provider needs, prescriptions, contribution strategy, and renewal timing.

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FAQ

Questions about HMO, PPO, EPO, and HDHP plans

Is an HMO always less expensive than a PPO?

No. Premiums often differ, but the practical cost depends on the exact plan, employer contribution, provider use, prescriptions, deductible, copays, coinsurance, and out-of-pocket exposure.

What is the main difference between an EPO and a PPO?

An EPO generally covers non-emergency care only within its network, while a PPO may provide out-of-network benefits at a higher member cost. Always confirm the exact plan documents because networks and rules vary.

Does every HDHP work with an HSA?

No. A plan must satisfy the current federal HSA-compatible HDHP requirements, and the individual cannot have disqualifying other coverage. Confirm the plan and personal eligibility before contributing.

Which plan type is best for a small business?

There is no universal best type. The right lineup depends on employee locations, provider preferences, prescriptions, expected care, employer budget, payroll deductions, and the plan options available to the group.

Should employees verify their doctors before enrolling?

Yes. Employees should check the exact plan network with both the carrier and provider and confirm the relevant facility, medical group, and specialist—not only the doctor’s name.