2025 AEP Insight: Plan Type Overview📊

HMO and PPO plans show market shifts, with new growth opportunities in 2025

October 21, 2024       Market Research

Table of Contents

New plans increase despite a reduction in total HMO and PPO offerings

All plan types are expected to see a decline in total availability in 2025. HMO plans continue to dominate with 61.9% of the market, though their count dropped to 3,518, down from 3,586 in 2024, continuing a downward trend. Similarly, PPO plans, which comprise 35.4% of all plans, decreased to 2,010 from 2,045 in 2024, reflecting a 1.7% YoY decline. In contrast to previous years, both HMO and PPO plan growth rates slowed in 2025. This overall contraction in HMO and PPO plans, following a period of growth through 2023, highlights a shift in the market.

Apart from HMO and PPO plans, no new plans were introduced in other categories. In 2025, there was a notable increase in new plan additions, reversing the trend from 2024. HMO plans grew by 12% YoY with 453 new plans, and PPO plans rose by 16% YoY, adding 357 new plans. Florida continues to lead in HMO plans with a total of 499 plans and 54 new ones, though this is fewer than in 2024. In contrast, Pennsylvania ranks first in PPO plans, showing growth from 2024. The total number of PPO plans increased from 136 to 164, with new plans rising from 21 to 36.

Other plan types, including Cost, MMP (Medicare-Medicaid Plans), MSA (Medical Savings Account), PFFS (Private Fee-for-Service), and Regional PPOs, collectively represent about 2.7% of the total plans. Among these, Cost plans fell from 57 to 50, and PFFS plans continued their downward trend, declining by 3 plans to a total of 24. The Regional PPO category also decreased, dropping from 60 to 51 plans. MMP plans saw a marginal decline by one plan, while MSA plans remained stagnant at 1.

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