Health Insurance Trends | HMOs, PPOs, and HSAs

If you own a small business, you highly value your employees and want to offer them the best health insurance package available. But determining which plans are the best fit can be hard. That’s why we’re offering our second annual benchmark report on health insurance– download it here for free!

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health insurance benchmark report

If you’re running a small business, we know you care deeply about your employees. One of the most important roles a company can play in its workers’ lives is providing the appropriate health insurance plans for them and their families. But between ACA regulations, a sea of acronyms, and geographical limitations, it can be extremely difficult to decide which plans to offer your employees. That’s why we’re here to offer our SMB benchmark report– this is fresh Zenefits data, pulled from over 4,000 customers (small businesses with under 100 employees) on what health insurance packages they’re currently offering. Download our full report at the bottom, and browse through some of the highlights below:

PPO, HMO, and HDHP Plans

From our data, SMBs overwhelmingly favor managed care strategies when offering health insurance benefits to their employers and very few choose to offer aggressive cost-sharing arrangements or savings vehicles.

Benchmark report- plan type chart


  • SMBs are almost twice as likely to offer a preferred provider organization (PPO) than health maintenance organization (HMO) on a national basis. However, HMOs remain popular in the west, where they were initially created.
  • Just 6% of small businesses nationally offer a high-deductible health plan (HDHP) and health savings account (HSA). The highest rate of HDHPs and HSAs are found in the central states at 10%. This is unsurprising, as the Central regions tend to favor PPOs.
  • A significant increase of HMOs in the Central region (41%) offers SMBs alternatives to large, pricey networks.
  • The Northeast saw a sizable drop in HMOs, about a 17% decrease.

Related: Small Business Health Insurance Report | Premiums and Contributions


According to our benchmark report, the West exhibited the largest drop in health savings accounts at 11%. This is likely because HMOs have become even more popular in this are, and health savings accounts pair with high deductible health plans, usually PPOs rather than HMOs.

HSA chart benchmark report


  • Health Savings Account options decline 5% nationally.
  • Once again, the western states were the only ones to fall below the national average, trailing behind the rest at just 12%.

Growing Trend

The south is about twice as likely to offer “other” types of health insurance plans (40%) compared to the national average (22%). Those coverages, which reflect efforts to find alternative solutions in the Central U.S., include:

  • Consumer-driven health plans
  • Hybrid plans, which meld the predictable cost of a fully insured group health plan with an ability to self-fund only the costs that are actually incurred.
  • Exclusive Provider Organizations (EPOs)
  • Accountable Care Organizations (ACOs)
  • Localized networks with centers of influence
  • Innovative risk-management insurance arrangement, or “level funding.” This self-insurance hybrid further enables companies to benefit from the regular and predictable cost of a fully insured plan, while only paying for the healthcare costs actually incurred by employees.

It’s a significant category, as well as a clear indicator of market innovation.

Want more information regarding premiums, contributions, coinsurance, deductibles and more? Download our full benchmark report below!

SMB benchmark report

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