Section 5: Market Shares of Health Plans
Health plans are often characterized into plan types based on their coverage for out-of-network services and their use of primary care gate keeping. In 2024, PPOs remain the most common plan type.
- Forty-eight percent of covered workers are enrolled in PPOs in 2024, followed by HDHP/SOs (27%), HMOs (13%), POS plans (11%), and conventional plans (1%). All of these percentages are similar to the enrollment percentages in 2023 [Figure 5.1].
- The percentage of covered workers enrolled in HDHP/SOs is similar to last year (29%) and five years ago (30%), but higher than the percentage 10 years ago (20%). The percentage of covered workers enrolled in PPOs has decreased 10% over the past decade [Figure 5.1].
- The percentage of covered workers enrolled in HMOs (13%) is similar to the percentages last year (13%) but lower than the percentage five years ago (19%) [Figure 5.1].
- A larger share of covered workers are enrolled in HDHP/SOs than in HMOs in both small and large firms [Figure 5.2].
- A similar share of covered workers in large firms and small firms are enrolled in HDHP/SO plans (29% and 24%). Covered workers in small firms are more likely than covered workers in large firms to be enrolled in POS plans (19% vs. 8%) [Figure 5.2].
- Plan enrollment patterns also differ across regions.
- HMO enrollment is significantly higher in the West (25%), and significantly lower in the Midwest (6%) [Figure 5.3].
- Covered workers in the Midwest (40%) are more likely to be enrolled in HDHP/SOs than workers in other regions, while covered workers in the West (19%) are less likely to be enrolled in HDHP/SOs [Figure 5.3].