Study: ACA plans offer narrower networks than ESI plans

Consumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage, according to an analysis released this week (Source: “Report: ACA plans have a third fewer providers than employer-based plans,” Washington Post, July 15, 2015).

According to the study by consulting firm Avalere Health, exchange plan networks include 42 percent fewer oncology and cardiology specialists; 32 percent fewer mental health and primary care providers; and 24 percent fewer hospitals.

In these “narrow networks,” health plans negotiate contracts with a select number of providers who agree to be reimbursed at lower rates. That means the insurers can set their premiums lower, at least theoretically. But, depending on the plan’s design, consumers typically pay more, and sometimes much more, if they use a doctor or hospital outside the network.

Care provided by out-of-network providers does not count toward the out-of-pocket limits put in place by the ACA.