Section 5: Market Shares of Health Plans - 10240 | KFF (2024)

FAQs

What percentage of people have HMO vs PPO? ›

PPOs are the most common plan type. Forty-seven percent of covered workers are enrolled in PPOs, followed by HDHP/SOs (29%), HMOs (13%), POS plans (10%), and conventional plans (1%) [Figure 5.1]. All of these percentages are similar to the enrollment percentages in 2022.

The study said that self-funded insurance plans, which means the employer collects premiums and bears responsibility for paying claims, rose from 55% of the market in 2015 to 60% of the market in 2021.

Best Health Insurance by Plan Type in California

The best providers for all plan types are: PPO: Health Net (MoneyGeek score: 100 out of 100) EPO: Anthem Blue Cross (MoneyGeek score: 100 out of 100) HMO: Kaiser Permanente (MoneyGeek score: 90 out of 100)

Doctors often prefer PPOs because they offer greater reimbursem*nt rates compared to HMOs and have less administrative paperwork. Is a PPO a good thing? For many, a PPO's flexibility and coverage make it a favorable choice, but it comes with higher premiums.

In general, PPO plans tend to be more expensive than an HMO plan. Your monthly premium will be higher and you will have to meet your deductible before your health insurer starts paying. You will also have to pay more out-of-pocket if you visit a provider who is not part of your PPO network.

Advantages of self-funded health plans

The employer retains funds when health claims are lower than expected. Self-funding a health plan is often less costly because: There are no profit or risk margins to pay to an insurer.

The $600 billion self-insured market being ignored by service providers at their own peril. Self-insured enrollment passed the commercial fully insured (group plans) enrollment in 2020 becoming the largest segment of the healthcare market.

The MultiPlan PHCS network is the nation's largest and most comprehensive independent PPO network. This network offers access in all states and includes more than 700,000 healthcare professionals, 4,500 hospitals and 70,000 ancillary care facilities. How do I find PHCS providers?

The most expensive health insurance in California is a platinum plan for an elderly adult, with an average monthly rate of $1982.

Kaiser Permanente Gets Set to Be the Leading Health Plan

While Anthem and Blue Shield are competing for the top spot on the health insurers chart in California, they need to be aware that other companies are catching up as well.

What is one disadvantage to a high deductible health plan? ›

It Is More Expensive to Manage a Chronic Illness With an HDHP. A chronic illness, such as heart disease or diabetes, can be much more expensive to manage under an HDHP than a traditional health care plan. With these conditions, regular medications and health screenings may be required.

Higher deductibles usually mean lower premiums for small businesses trying to find ways to cut costs and save.

HMO enrollees made up 34.8 percent of the total U.S. civilian noninstitutionalized population and 41.9 percent of the population with health insurance (Table 1). The rate of HMO enrollment was significantly higher in the non-elderly population than in the elderly population (45.6 vs. 20.1 percent).

Preferred Provider Organization (PPO): With a PPO, you may have: 1) A moderate amount of freedom to choose your health care providers-- more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist. 2) Higher out-of-pocket costs if you see out-of-network doctors vs.

HMO's typically provide lower copays for office visits, lower deductibles (sometimes no deductible) and much less out of pocket for hospitalization.