Just How Narrow Are Obamacare’s ‘Narrow Networks’?

The average Obamacare health plan’s provider network includes 34 percent fewer health care providers than the typical commercial plan, according to an analysis by Avalere, a Washington, D.C.-based health care consultancy.

Such exchange plan networks include 42 percent fewer oncologists and cardiologists, 32 percent fewer mental health experts and primary care doctors, and 24 percent fewer hospitals, Avalere said Wednesday. The study that supports complaints by some consumers and advocacy groups that some of the exchanges created under the Affordable Care Act offer “narrow networks” where patient options are considerably constrained.

Those same five categories (oncologists, cardiologists, mental health specialists, primary care doctors and hospitals) are used by the federal Centers for Medicare and Medicaid Services or CMS in evaluating whether health plans that participate in exchanges under the Affordable Care Act meet its “adequacy standards.”

But Avalere’s analysis was meant to quantify “anecdotal reports that exchange networks contain fewer providers” and explore how different health plan designs work (or don’t work) on the exchanges, as opposed to attempting to provide ammunition in the political and consumer advocacy battles over narrow exchanges.

“Given the new requirements put in place by the ACA, network design is one way plans can drive value-based care and keep premiums low,” Dan Mendelson, Avalere’s CEO, said in the statement. Both are key goals of President Barack Obama’s signature health care reform law, which was upheld again last month by the U.S. Supreme Court.

Recommended Articles

AI in Healthcare: Calls for Stricter Standards Amid OpenAI Leadership Shuffle

Recent disruptions in OpenAI’s top brass have sparked intense dialogue within the healthcare sector, emphasizing the urgent need for robust standards governing the implementation of generative AI technologies. With Microsoft recruiting former OpenAI executives Sam Altman and Greg Brockman, concerns are growing that few corporations may soon dictate the trajectory of healthcare AI, potentially molding ...

Read More

2024 FSA, HSA, and HDHP Plan Limits

A health Flexible Spending Account (FSA) is an employer-sponsored benefit that allows eligible employees to save pre-tax dollars to pay for qualified medical expenses. Employees can elect a specific dollar amount, up to a certain limit, to set aside annually.

Read More

Proposals On PBMs And Medical Devices Advanced By House Subcommittee

The House Committee on Energy and Commerce health subcommittee pushed forward 21 proposals on Tuesday, some of which will restrict the power of pharmacy benefit managers (PBMs). Democrats supported many of the proposals put forward by Republicans, including legislation reining in PBMs that had support from 60 organizations representing patients, providers, pharmacists, small businesses and ...

Read More

CMS Tightening Network Adequacy Standards For Exchange Plans

Beginning in 2025, health plans sold in state-run insurance exchanges would be required to meet time and distance standards that are at least as adequate as mandated on federal marketplaces, according to a rule released by the Centers for Medicare & Medicaid Services (CMS) on Wednesday. Time and distance standards would be calculated at the ...

Read More
arrowcaret-downclosefacebook-squarehamburgerinstagram-squarelinkedin-squarepauseplaytwitter-squareyoutube-square