HMO and PPO Labels are Poor Indicators of Provider Networks and Prices

Clicks: 7
ID: 333681
2026
Free PDF
Article Quality & Performance Metrics
Overall Quality
Not rated
Combines reader engagement with the AI quality analysis. This article has not been analysed, so there is no overall score — reader engagement is measured and shown alongside.
AI Quality Assessment
Not analyzed
Readership in this journal
Emerging

Ranked #159 of 168 articles by views in Health Affairs Scholar

Most read Least read

Bar heights use a square-root scale. Only the 120 most-read articles are drawn; the journal has 168 in total.

Mint this article as an NFT
Not yet minted

Create a permanent, verifiable on-chain record of this article on the Scimatic Network. The NFT is held in your Journament account, and you can withdraw it to your own wallet at any time.

5 SUSD one-off · no wallet required
Sign in to mint
Abstract
Abstract Introduction Commercial insurance is commonly organized around health maintenance organization (HMO) and preferred provider organization (PPO) products. HMOs are often associated with narrower, less expensive networks, but this assumption has been difficult to test. We examined whether these labels correspond to differences in provider networks and negotiated prices within insurers. Methods We analyzed 2026 Q3 Transparency in Coverage data from commercial insurers whose network or plan names identify both an HMO and a PPO network. We compared provider-network overlap and negotiated prices for identical provider-service combinations. Insurers were grouped by whether HMO and PPO products differed in network breadth, prices, both, or neither. Results Of the 30 insurers, 14 had identical networks and prices, 13 of them using a single network for both products, while 8 had differences in both. Across 90.4 million within-provider comparisons, 71.5% of negotiated rates were identical, 22.6% had higher PPO rates and 5.9% had higher HMO rates. Conclusions HMO and PPO labels do not consistently identify differences in network breadth or negotiated rates, and many insurers do not use the labels at all. For many insurers, product differences may instead reflect benefit design, which this study did not measure.
Reference Key
openalex_W7223351704 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors David B. Muhlestein, Elvira Makk Frid
Are you one of these authors? Claim your profile
Journal Health Affairs Scholar
Year 2026
DOI
10.1093/haschl/qxag296
URL
https://doi.org/10.1093/haschl/qxag296
Keywords Keywords not found

Citations

No citations found. To add a citation, contact the admin at info@scimatic.org

Comments

No comments yet. Be the first to comment on this article.