PPO
Preferred Provider Organization. Employees can see any doctor, in-network or out-of-network, without needing a referral. The most flexible option, but premiums are usually the highest of the three.
Most flexibleMost Texas small groups choose one of three plan structures: PPO, HMO, or a high-deductible plan with an HSA. Each one trades flexibility against cost in a different way. Here is how they actually work.
There is no perfect plan, only the one that fits your team and budget. Here is what each structure means in plain language.
Preferred Provider Organization. Employees can see any doctor, in-network or out-of-network, without needing a referral. The most flexible option, but premiums are usually the highest of the three.
Most flexibleHealth Maintenance Organization. Lower monthly premiums in exchange for staying inside a specific network. Employees pick a primary care doctor and need a referral to see a specialist.
Lowest premiumHigh-Deductible Health Plan paired with a Health Savings Account. Lower premiums plus a tax-free savings account that both you and your employees can fund for medical expenses.
Tax savingsA PPO gives employees the widest choice of doctors and hospitals. They do not need a referral to see a specialist, and out-of-network care is still covered, usually at a higher coinsurance rate.
This is the right fit when your team values convenience and choice over saving a few dollars on the premium. It is also the easiest plan to explain because it works closest to how people expect health insurance to work.
Compare PPO ratesAn HMO keeps premiums down by asking employees to coordinate care through a primary care physician. If the network is strong in your area and your employees do not mind the referral step, the savings are real.
The catch is out-of-network care. Except for emergencies, it is generally not covered. If your team already uses doctors inside the HMO network, this is often the most cost-effective choice.
Compare HMO ratesA High-Deductible Health Plan has the lowest monthly premium of the three, but the employee pays more out of pocket before coverage kicks in. The upside is the Health Savings Account.
You and your employees can contribute pre-tax dollars into the HSA, and the money rolls over year after year. It can be used for deductibles, copays, prescriptions, and even some dental and vision costs. For a healthy team that does not use much care, this is the cheapest total-cost option.
Compare HDHP + HSA ratesIn Texas, the rules and the market shift once you cross 50 full-time-equivalent employees. Here is what that means for your plan options.
These employers buy ACA small-group plans. Coverage is guaranteed-issue, carriers cannot deny anyone for health reasons, and pricing is community-rated based on age and location, not medical history.
Large groups move into a different market with more plan design flexibility and typically more negotiating leverage. Rates can be experience-rated, and carriers may offer custom plan configurations.
Under the ACA, employers with 50 or more full-time-equivalent employees must offer affordable, minimum-value coverage or face penalties. We help you stay compliant while controlling cost.
If you are near the 50-employee line, some carriers offer special mid-market products that bridge the gap. We will find the one that fits your size and your budget.
We compare PPO, HMO, and HDHP + HSA from every major Texas carrier and show you the real numbers.