Narrow networks prevalent in exchange plans

Narrow networks prevalent in exchange plans

0127ppacaap-crop-600x3381-crop-600x338Few insurance plans available through Obamacare’s exchange system advertise themselves as “narrow network.” It’s not exactly a strong come-on to most consumers.

But at least 41 percent of the popular silver plans sold via exchange in 2014 did, in fact, have what amounted to a narrow network when measured by how many physicians in the plan area were included in the network.

In what they say is the first time networks have been examined through the lens of individual physicians instead of hospitals, researchers at the University of Pennsylvania’s Leonard Davis Institute of Health Economics concluded that many consumers may have unknowingly chosen a narrow network that did not include their “trusted” clinicians.

The study, funded by the Robert Wood Johnson Foundation, said that 11 percent of exchange silver plans fell into the “extra small” network category, which includes plans that have less than 10 percent of area physicians included in the network. The “small” category included the 30 percent of narrow network plans, which fell in the 10-25 percent inclusion range.

The study found health maintenance organizations tended to offer the narrowest network plans when compared to PPOs. Further, when examined by physician specialty, the study found that “in primary care, 36 percent of networks are considered small or x-small, compared to 23 percent for internal medicine subspecialties, and 59 percent for oncology.”

“Provider network size and composition has become an important part of how insurers price marketplace plans and attract consumers, but so far, consumers do not have usable information about provider networks,” said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation.

“Consumers need to be able to see the forest as well as the trees when they make a plan choice and these data are a first step in giving them the full picture of which physicians are covered under specific plans.”

The authors said any measures that would allow consumers “to quickly ascertain if a physician they trust is covered under a specific plan” would help them make better choices. Additionally, they recommended labeling networks in “easy-to-understand” language, using such labels as x-small, small, medium and large.