What happens when…
Priya is worried about losing her PPO
Why the broadest network isn't always the best — and when it is.
Priya has been on her company’s PPO for six years.
It covers tens of thousands of providers. She heard ICHRA means losing it. She’s worried.
Priya sits inside a single large box labelled as her company’s PPO, a network of tens of thousands of providers costing $680 a month.
Her company’s PPO · six years
Tens of thousands of providers · $680/mo
But Priya sees three providers.
Her primary care doctor. Her daughter’s pediatrician. The hospital five minutes from her house. That’s her actual healthcare.
Three providers are picked out of Priya’s PPO network — her primary care doctor, her daughter’s pediatrician, and the hospital near her house — while the rest of the network goes unused.
3 providers Priya actually uses
Her actual healthcare
- Primary care doctor
- Priya
- Pediatrician
- Her daughter
- Hospital
- Five minutes from her house
- The rest of the network
- Unused
She finds a plan that covers all three — for $300 less.
The network is smaller. But she chose it. It includes every provider she actually uses.
Priya’s wide PPO is set beside the smaller HMO she picks: both cover all three of her providers, but the HMO costs $380 a month instead of $680.
| Measure | Her PPO | The plan she picked |
|---|---|---|
| Network | 50,000+ providers | Smaller |
| Her three providers | Covered | Covered |
| Most of the network | Unused | — |
| Monthly premium | $680/mo | $380/mo |
Priya’s choice: HMO, $300 less a month
But not everyone is Priya.
James manages a complex condition and sees eight specialists across two hospital systems. He needs a broad network — and on the individual market, he can find one. The difference is that with ICHRA, James picks the breadth he needs, and Priya doesn’t pay for breadth she doesn’t.
Priya and James are shown side by side: Priya on a smaller HMO at $380 a month for three providers, James on a broad network at $580 a month for eight specialists across two hospital systems.
| Measure | Priya | James |
|---|---|---|
| Providers they see | 3 | 8 specialists |
| Hospital systems | One, five minutes away | Two |
| Network they picked | Smaller HMO | Broad |
| Monthly premium | $380/mo | $580/mo |
Group plans need the widest possible network because everyone’s on the same plan.
That’s why group defaults to PPO — it’s the only way to cover everyone’s doctors at once. When each person shops individually, they pick the network that fits their providers. That might be broad for James and narrow for Priya. Both are right.
Above, Priya and James share one group PPO wide enough to cover them both. Below, they hold separate plans — Priya an HMO at $380 a month, James a broad network at $580 a month.
Group plan
One network for everyone — so it has to be the widest
With ICHRA, each picks their own
Both chose what fits their life. Neither is paying for the other’s network.