PPO plans enroll three-in-five covered workers in 2006, followed by HMO plans, POS plans, and then HDHP/SOs and conventional plans.
With the highest enrollment, PPO plans cover 60% of covered workers. HMO plans cover 20% of covered workers, POS plans cover 13% of covered workers, and HDHP/SOs and conventional plans cover 4% and 3% of covered workers, respectively (Exhibit 5.1).
Plan enrollment patterns differ across regions.
Lower percentages of covered workers are enrolled in HMO plans in the Midwest and in the South, 16% and 17% respectively. In contrast, HMO enrollment is significantly higher (29%) in the West than in all other regions. A higher percentage of covered workers are enrolled in PPO plans in the Midwest (66%), and fewer are enrolled in the West (51%). For POS plans, enrollment is lowest in the Midwest at 10%. Finally, covered workers are less likely to be enrolled in an HDHP/SO in the Northeast (2%) and more likely to be enrolled in an HDHP/SO in the Midwest (6%) (Exhibit 5.2).
This year we have added high deductible health plans with a savings option, or HDHP/SOs, as a plan type for the survey. HDHP/SOs include (1) health plans with a deductible of at least $1,000 for single coverage and $2,000 for family coverage offered with a health reimbursement arrangement, or HRA; and (2) high deductible health plans that meet the federal legal requirements (see Section 8) to permit an enrollee to establish and contribute to a health savings account, or HSA. This definition does not include other consumer-directed plan options, such as arrangements that combine an HRA with a lower-deductible health plan or arrangements in which an insurer (rather than the employer as in the case of HRAs or the enrollee as in the case of HSAs) establishes an account for each enrollee. Other arrangements may be included in the survey as the market evolves.
The addition of HDHP/SOs as a plan type means that caution must be taken when comparing enrollment estimates by plan type in 2006 to estimates from previous years. Plans that are now classified as HDHP/SOs would have been classified as PPOs, HMOs, POS plans, or conventional plans in previous years, so any differences from prior years may result in part from this reclassification. Furthermore, the removal of HDHP/SOs from the other plan types may also affect the year-to-year comparisons for the other plan types.
Exhibit 5.1: Distribution of Health Plan Enrollment for Covered Workers, by Plan Type, 1988-2006
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Exhibit 5.2: Health Plan Enrollment, by Firm Size, Region, and Industry, 2006
Conventional
HMO
PPO
POS
HDHP/SO
FIRM SIZE
3-24 Workers
5%
13%*
52%*
24%*
6%
25-49 Workers
4
22
46*
26*
2
50-199 Workers
2
19
61
12
6
200-999 Workers
3
17
67*
11
2*
1,000-4,999 Workers
2
25*
62
8*
3
5,000 or More Workers
4
23
60
9*
4
All Small Firms (3-199 Workers)
4%
17%*
55%*
19%*
5%
All Large Firms (200 or More Workers)
3%
22%*
62%*
9%*
3%
REGION
Northeast
3%
23%
59%
13%
2%*
Midwest
3
16*
66*
10*
6*
South
4
17*
61
14
4
West
3
29*
51*
14
3
INDUSTRY
Agriculture/Mining/Construction
4%
7%*
62%
18%
10%
Manufacturing
4
16*
64
9*
8*
Transportation/Communications/Utilities
2
20
69*
7*
1*
Wholesale
5
17
63
9
6
Retail
2
19
59
18
2
Finance
3
19
65
10
3
Service
3
20
57
17*
3
State/Local Government
8
39*
41*
11
1*
Health Care
2
23
61
10
4
ALL FIRMS
3%
20%
60%
13%
4%
*
Estimate is statistically different within plan type from estimate for all other firms not in the indicated size, region, or industry category at p<.05.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
