- Health plans with more restrictive networks constitute 73% of the 2018 ACA exchange market, up from 68% in 2017 and 54% in 2015, a new Avalere analysis shows.
- At the same time, patients face higher out-of-pocket costs. The average deductible for the popular silver plans is $3,937, up from $3,703 this year, while gold plans will rise to $1,142 from $1,051. Deductibles for bronze and platinum plans will be lower than 2017.
- The analysis is based on 2015-2018 plan information for states participating in the federally facilitated exchanges as well as California and New York, which have the highest exchange enrollment.
Restrictive network plans such as health maintenance organizations and exclusive provider organizations have fewer in-network providers and fewer options across specialists than less-restrictive plans. Yet just 27% of plans in the 2018 marketplace are preferred provider organizations or point of service plans, which offer broader physician networks, the report says.
“We continue to see insurers focusing on narrow network exchange products that enable them to offer competitive premiums and manage medical costs,” Caroline Pearson, senior vice president at Avalere, said in a statement. “These narrow network plans may come at a lower price tag for consumers, but they may also limit consumer choice and access to specialist care.”
President Donald Trump has done away with the cost-sharing subsidies that help to check out-of-pocket costs for lower-income Americans. His administration also wants to do away with the individual mandate, which would result in fewer young and healthier individuals in the exchanges. That would result in unbalanced risk pools and drive up premiums for those remaining in the exchanges.
The Trump administration has also halved the open enrollment period for ACA plans this year, gutted its advertising budget and limited access to healthcare.gov to one day on most weekends, when most people try to sign up.
These moves have caused some payers to quit the exchanges altogether, while others are proposing raising premiums by more than 20%.
The uncertainty has resulted in nearly half of U.S. counties having only one ACA plan in 2018. Less competition not only reduces members’ choices, it also gives insurers more leverage in negotiations with providers over prices, networks and cost-sharing arrangements.
Ultimately, higher prices could lead to more people leaving the exchanges and more bad debt for hospitals.