Guide to U.S. HMOs and PPOs, 2025

This 37th edition of Guide to U.S. HMOs & PPOs profiles nearly 900 managed care organizations in the United States. It lists current, comprehensive information for HMO, PPO, POS, and Vision & Dental Plans. Comprehensive coverage - from state listings to consolidations in the health insurance industry - is the cornerstone of this new edition.

In addition to detailed profiles of managed healthcare organizations, this edition contains many up-to-date reports containing charts, data, and maps that provide readers with a bigger picture of both healthcare plans and organizations in the United States.

Plan profiles are arranged alphabetically by state. The first page of each state chapter is a State Summary chart of Health Insurance Coverage Status and Type of Coverage by Age. This chart includes a number of categories, from “Covered by some type of health insurance” to “Not covered at any time during the year.”

Directly following the State Summary, plan listings provide crucial contact information, including key executives, often with direct phones and e-mails where available, fax numbers, web sites and hundreds of e-mail addresses.

Each profile provides a detailed summary of the plan, including the following:

• Type of Plan, including Specialty and Benefits
• Type of Coverage
• Type of Payment Plan
• Subscriber Information
• Financial History
• Average Compensation Information
• Employer References
• Current Member Enrollment
• Hospital Affiliations
• Number of Primary Care and Specialty Physicians
• Federal Qualification Status
• For Profit Status
• Specialty Managed Care Partners
• Regional Business Coalitions
• Employer References
• Peer Review Information
• Accreditation Information

In addition to the detailed front matter, state statistics, and comprehensive plan profiles, the Guide to U.S. HMOs & PPOs includes two Appendices and five Indexes.

• Appendix A: Glossary of Health Insurance Terms: Includes more than 150 terms such as Aggregate Indemnity, Diagnostic Related Groups, Non-participating Provider, and Waiting Period.
• Appendix B: Industry Web Sites: Contains dozens of the most valuable health care web sites and a detailed description, from Alliance of Community Health Plans to National Society of Certified Healthcare Business Consultants.
• Plan Index: Alphabetical list of insurance plans by seven plan types: HMO; PPO; HMO/PPO; Dental; Vision; Medicare; and Multiple.
• Personnel Index: Alphabetical list of all executives listed, with their affiliated organization.
• Membership Enrollment Index: List of organizations by member enrollment.
• Primary Care Physician Index: List of organizations by their number of primary care physicians.
• Referral/Specialty Care Physician Index: List of organizations by their number of referral and specialty care physicians.

The Guide to U.S. HMOs and PPOs is an invaluable resource for anyone within the healthcare industry, a much-used marketing tool for companies who provide materials and services to the managed care industry, and a useful reference for consumers seeking education and information about the world of managed care. This one-stop source has proven to be the premier guide in its field, containing an unprecedented amount of up-to-date information in a clear and easy-to-use format.