Simple Healthcare research on network labels selected as Editor’s Choice in Health Affairs Scholar
ORLANDO , FL, UNITED STATES, October 27, 2026 /EINPresswire.com/ — Employers and consumers choosing between HMO and PPO health plans may find the same providers at the same negotiated prices, according to new research from Simple Healthcare published in Health Affairs Scholar.
The study examined 30 insurers offering identifiable HMO and PPO networks. Fourteen had identical provider networks and negotiated prices, challenging the assumption that HMOs consistently offer narrower, less expensive networks.
“Employers should ask what they are actually getting when they choose between an HMO and a PPO,” said David Muhlestein, author of the study and CEO of Simple Healthcare. “A different label alone is not enough to establish that a plan offers broader provider access or better negotiated prices.”
Researchers David Muhlestein, PhD, JD, and Elvira Makk Frid, MPP, analyzed third-quarter 2026 Transparency in Coverage data. Across 90.4 million comparisons of prices for the same service from the same provider, 71.5% were identical between HMO and PPO networks. PPO prices were higher in 22.6% of comparisons; HMO prices were higher in 5.9%.
Differences remained important for some insurers: eight had differences in both networks and prices. The findings therefore support examining individual products rather than assuming all HMO and PPO offerings are alike.
By using publicly available negotiated-rate data, the paper provides a way to examine differences that plan labels alone cannot reveal. For employers and brokers evaluating coverage options, the findings underscore the value of looking beyond just the plan label to identify cost savings opportunities.
The analysis did not measure benefit design. Differences in cost sharing, referral requirements, or out-of-network coverage may distinguish products even when their networks and negotiated prices match.
The article, “HMO and PPO Labels are Poor Indicators of Provider Networks and Prices,” was published October 23 and selected as an Editor’s Choice article.
Read the study: https://doi.org/10.1093/haschl/qxag296
About Simple Healthcare
Simple Healthcare is an independent healthcare data and analytics company that helps employers and their advisors understand healthcare prices and identify opportunities to lower costs. By combining publicly available negotiated rates with claims data and research-driven methods, the company turns complex information into actionable insights for evaluating health plans, comparing providers, and prioritizing cost-saving strategies. Learn more at www.simplehc.com.
Nancie Steinberg
Simple Healthcare
nbsteinb@gmail.com
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