By Lynne Adkins

PHILADELPHIA (CBS) — There are changes in the choices this year in the healthcare open market — and not everyone is thrilled.

Preferred provider organizations (PPOs) give participants more choices in doctors and hospitals than HMO’S, which keeps out of pocket expenses lower. But there are fewer PPO choices on the marketplace this year and those available are more expensive, according to Mark Stehr, associate professor of economics at Drexel University.

“The sicker or higher-risk people tend to flock to the more generous plan,” Stehr says, “and that tends to push costs up in that plan, which then requires an increase in the premium for the plan to stay financially viable.”

He says the healthier consumer can afford to limit options and expenses.

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