The generosity of health insurance networks can be measured in terms of type and breadth. The type of network ranges from a health maintenance organization (HMO), which is generally more restrictive in terms of which providers are covered, to a preferred provider organization (PPO), which allows access to all providers but incentivizes using in-network providers. The breadth of network is usually differentiated between the number of physicians or medical groups that are in-network and by the included facilities.
This week’s Paragon Pic, from a forthcoming Paragon research paper, maps the market share by type of network from 2014 to 2023, illustrating that individual market enrollment has shifted toward plans that include fewer providers and facilities in their networks. In 2014, 50 percent of individual market consumers were in PPO and point-of-service (POS) plans. By 2023, that percentage had declined to 17 percent. In 2023, 83 percent of enrollees were in the more restrictive HMOs or exclusive provider organizations (EPOs).
