The plan type decides which doctors you can see, whether you need referrals, and what happens outside the network. It matters as much as the price.
HMO (Health Maintenance Organization)
- You use doctors and hospitals in the plan's network.
- You usually choose a primary care provider and need a referral to see specialists.
- Out-of-network care is usually not covered, except emergencies.
- Often the lower premium.
PPO (Preferred Provider Organization)
- Lower costs in the network, but some coverage out of the network too, at a higher cost.
- No referral needed for specialists.
- Often a higher premium, but more freedom, which helps if you travel, split time out of state, or want a specific out-of-network doctor.
EPO and POS
An EPO works like a PPO inside the network (no referrals) but, like an HMO, does not cover out-of-network care except emergencies. A POS mixes the two: a primary care doctor and referrals, with some out-of-network coverage.
What Maine insurers offer
For 2026, the Maine Bureau of Insurance listed HMO and PPO plans from Anthem, Community Health Options and Harvard Pilgrim in the individual market. The exact mix for 2027 is shown on each plan in CoverME.gov, so check the plan type, not just the insurer.
How to choose
- List your doctors, hospital and prescriptions, and check each plan's network and drug list.
- If you split time out of state or have a student away at school, ask how each plan covers care there.
- If you are happy with doctors in one network, an HMO can save money.
- Compare the out-of-pocket maximum, not just the premium.
Common questions
What is the difference between an HMO and a PPO?
An HMO usually limits you to its network and needs referrals for specialists; a PPO lets you see specialists without a referral and pays some out-of-network costs, usually for a higher premium.
Are emergencies covered out of network on an HMO?
Yes. Emergency care is covered at in-network cost sharing on any Marketplace plan, in or out of network.
Which plan types are sold on CoverME.gov?
For 2026 the Maine Bureau of Insurance listed HMO and PPO plans from the three insurers. Check each 2027 plan's type on CoverME.gov.
Related guides
Checked October 2026. Sources:
Not legal or tax advice. Rules and prices change; if a number here affects you, call 207-631-3546 and we will check it for your household for free.
Want your own numbers? Get a free quote or call 207-631-3546.