Dive Brief:
- A state-by-state analysis by the Robert Wood Johnson Foundatio provides one of the first studies of the size of provider networks among plans sold through ACA health insurance marketplaces.
- The authors note that plans are increasingly turning to narrow networks as one of the few remaining options to keep premiums low, now that they must cover those with pre-existing conditions and cover a wider range of healthcare services.
- "As the prevalence of narrow provider networks increases, the ability to measure their size, assess their adequacy, and transparently communicate this information to consumers and regulators becomes essential," the authors write.
Dive Insight:
As the next enrollment period approaches, the RWJF analysis is intended to help both regulators and consumers assess the trade-off of narrowing network size for lower premiums.
The authors note that currenty, it is difficult for consumers to grasp the impact of narrow networks, even as a broad concept, because it is not transparent. They argue that it is difficult for consumers to gauge which providers will be available to them because that requires checking provider directories which are "notoriously out-of-date" and finding one that can accept a new patient within a reasonable of time.
For regulators, there is also difficulty in judging the adequacy of such networks, which they note is something the ACA requires. "The federal standards require networks to have sufficient numbers and types of providers to deliver services without “unreasonable delay,” they note, but “unreasonable” is up to states to determine.
The report highlights four states where at least three out of four marketplace plans have narrow networks that cover 25% or fewer of all area physicians.
Those states with the highest percentage of narrow networks in ACA plans are:
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Georgia (83%)
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Florida (79%)
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Oklahoma (78%)
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California (75%)