Dive Brief:
- The US Department of Health and Human Services is considering mandating that the public insurance exchanges conform to the same rules for their provider networks as Medicare Advantage plans. David Cusano of the Georgetown Health Policy Institute recently informed the Health Insurance and Managed Care Committee at a meeting of the potential changes.
- HHS has been studying the potential impact of setting new standards for the exchanges. Medicare Advantage plans have regulations on the minimum number of providers on each plan and the maximum distance enrollees have to drive to see a provider in their network. The Affordable Care Act set looser standards for provider networks on the exchanges.
- Proponents of larger networks argue that some beneficiaries on the exchanges have had a difficult time getting care because of a dearth of nearby providers. But others argue that many people would rather pay less for a plan that has a smaller network and that it would be more beneficial to focus on specific plans with access issues than to create a blanket policy.
Dive Insight:
Narrow networks have become one of the most conflicting practices that have emerged from the Affordable Care Act implementation (though they did exist prior to the ACA). Insurers are able to reduce the cost of plans by signing with a smaller group of physicians; ones frequently chosen because they will accept lower payments for treatment. These plans are growing in popularity, up from 15% of employer plans in 2007 to 23% in 2012 according to the Washington Post.
Though they do save costs, patients have traditionally not liked the plans because some lose their doctors and fear that their care (at smaller systems) will be below par. Some have complained that they have to drive long distances to even find providers in their network.
Want to read more? You may want to read this story on the new Medica narrow network plan that relies exclusively on the Mayo Clinic.