2016 Employer Health Benefits Survey

Section Five: Market Shares of Health Plans

Enrollment remains highest in PPO plans, covering just under half of covered workers, followed by HDHP/SOs, HMO plans, POS plans, and conventional plans. Enrollment distribution varies by firm size: for example, PPOs are relatively more popular for covered workers at large firms (200 or more workers) than small firms (3-199 workers) (52% vs. 39%) and POS plans are relatively more popular among small firms than large firms (18% vs. 4%). Enrollment in HDHP/SOs has increased significantly over the past two years while enrollment in PPOs has fallen.

• Forty-eight percent of covered workers are enrolled in PPOs, followed by HDHP/SOs (29%), HMOs (15%), POS plans (9%), and conventional plans (< 1%) (Exhibit 5.1). More covered workers are enrolled in HDHP/SO plans than in HMOs in both small firms and large firms (Exhibit 5.2).
• The percentage of covered workers enrolled in HDHP/SOs in is similar to last year but has grown significantly since 2014 (29% vs. 20%).¹ Since 2014, enrollment in PPOs has fallen significantly (48% vs. 58%) (Exhibit 5.1).
• Plan enrollment patterns vary by firm size.
  • Covered workers in large firms are more likely than covered workers in small firms to enroll in PPOs (52% vs. 39%). Covered workers in small firms are more likely than covered workers in large firms to enroll in POS plans (18% vs. 4%) (Exhibit 5.2).
  • The share of covered workers in HDHP/SOs is similar for large firms and small firms (Exhibit 5.2).
• Plan enrollment patterns also differ across regions.
  • HMO enrollment is significantly higher in the West (30%) and significantly lower in the South (10%) and Midwest (6%) (Exhibit 5.3).
  • Covered workers in the South (57%) are more likely to be enrolled in PPOs than workers in other regions; covered workers in the West (35%) and the Northeast (39%) are less likely to be enrolled in a PPO (Exhibit 5.3).
  • Enrollment in HDHP/SOs is similar across regions (Exhibit 5.3).
• Plan enrollment patterns differ by industry as well.
  • Covered workers in the agriculture/mining/construction, (5%), manufacturing (8%) and finance (8%) are less likely to be enrolled in an HMO plan than covered workers in other industries. Covered workers in the service industry (20%) are more likely to be enrolled in an HMO than covered workers in other industries (Exhibit 5.3).
  • Covered workers in the state/local government (64%) are more likely to be enrolled in a PPO plan than covered workers in other industries. Covered workers in the finance industry (32%) are less likely to be enrolled in a PPO than covered workers in other industries (Exhibit 5.3).
  • Covered workers in the state/local government (19%) and agriculture/mining/construction industries (15%) are less likely to be enrolled in an HDHP/SO plan than covered workers in other industries. Covered workers in the finance industry (49%) are more likely to be enrolled in an HDHP/SO than covered workers in other industries

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Section Five: Market Shares of Health Plans

exhibits

Distribution of Health Plan Enrollment for Covered Workers, by Plan Type, 1988-2016

Download Exhibit 5.1

Distribution of Health Plan Enrollment for Covered Workers, by Plan Type and Firm Size, 2016

Download Exhibit 5.2

Distribution of Health Plan Enrollment for Covered Workers, by Firm Size, Region, and Industry, 2016

Download Exhibit 5.3