Study Finds Almost Half Of Health Law Plans Offer Very Limited Physician Networks
If the physician networks for plans sold on the health law鈥檚 online insurance exchanges were T-shirts, more than 40 percent would be size X-small or small. That鈥檚 the takeaway from a new study that analyzed nearly 400 physician networks in silver-level plans sold around the country聽 in 2014.
labeled 11 percent of plans 鈥渆xtra small鈥 because they covered fewer than 10 percent of physicians in a plan鈥檚 region. Another 30 percent were 鈥渟mall,鈥 meaning they covered between 10 and 25 percent of physicians. Just 11 percent of plans were classified as 鈥渆xtra large鈥 because they covered at least 60 percent of physicians in the area.
As consumers shop for coverage on the exchanges, knowing the trade-off between premium price and network size could be important to some, says Kathy Hempstead, director of the coverage team at the Robert Wood Johnson Foundation, which funded the study.
鈥淧eople don鈥檛 have a good way to understand what they鈥檙e buying,鈥 Hempstead says. 鈥淚 think we need to frontload more consumer information, and what your network is like is important.鈥
Plan type isn鈥檛 a good indicator of network size, according to the study by researchers at the University of Pennsylvania鈥檚 Leonard David Institute of Health Economics.聽Eighty percent of the plans offered on the marketplaces were either preferred provider organizations or health maintenance organizations. Yet even though HMOs typically don鈥檛 cover any out-of-network providers, more than half of HMO physician networks were either small or very small. By contrast, only a quarter of PPOs, which typically cover providers who are outside the plan鈥檚 network, had physician networks that were classified as either small or very small.
Under the health law, 鈥渕aintain a network that is sufficient in number and types of providers 鈥 to assure that all services will be accessible to enrollees without unreasonable delay.鈥
Previously, the consulting firm McKinsey & Co. based on the proportion of hospitals that participated in a plan鈥檚 service area. This is the first study to examine physician participation in exchange plan networks, Hempstead says.
鈥淚f you鈥檙e going to be in a direct-to-consumer market you have to be ready for these issues,鈥 she says.
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