‘Narrow’ Networks Pose Health Plan Dilemma

Jan. 30--Consumers rushing to obtain insurance under the federal health law should read the fine print, advisers say, on plans with the lowest premiums.

In many cases, policies with low monthly costs have relatively narrow networks of doctors and hospitals. Enrollees typically pay significantly more if they opt for care from providers that aren't in the network.

Network limits aren't new, but more plans with smaller networks have popped up on the market statewide, and shoppers are giving them a look as they scramble to deal with big premium jumps.

"The cheapest is always something that needs a conversation," said Richard Lett, an insurance agent in Woodbury. "Cheapest in premium may not be cheapest by year-end."

Sunday marks the close of open enrollment in the state's individual market, where about 300,000 Minnesotans buy coverage for themselves and their families. These consumers can shop either through the state's MNsure health insurance exchange or the larger "off-exchange" market where people buy directly from insurers or through agents.

The individual market is a slice of the health insurance world that has undergone significant changes with the federal Affordable Care Act, which launched MNsure and other government-run exchanges as a way to help lower the nation's uninsured rate.

The health law requires almost all Americans to have health insurance or pay a tax penalty. This year, it costs $695 or 2.5 percent of household income, whichever is higher.

In 2014 when major health law changes kicked in, premiums in Minnesota's individual market were among lowest in the nation. They've jumped significantly since then, with 2016 rates up by an average of 41 percent. The spike explains a shift by many MNsure consumers into "bronze" health plans with high deductibles that can run about $6,000 for an individual.

The trends make some consumers question the value of coverage, said Heidi Mathson, president of the Minnesota Association of Health Underwriters, a trade group for insurance agents. Those who opt for narrow networks to save on premiums run a risk, because "it takes a lot of homework to make sure your providers are in the network," she said.

Mathson added that, in most cases, she steers people away from narrow network plans. "I've just had too many experiences with clients who didn't have services covered because of network problems."

With tight networks, providers often trade a discount in the price they charge for services for access to a larger volume of patients, said Cynthia Cox, a researcher with California's Kaiser Family Foundation.

Just what is 'narrow'?

There's no set definition for what constitutes a broad or a narrow network. While they must meet standards set by regulators, there are varying degrees of "skinny" or "narrow."

The plans usually direct patients to receive much of their care within one health system, rather than letting patients choose from doctors or hospitals throughout the community. The idea is that when one health care system is responsible for a patient's care, there's less duplication of services and better prevention that keeps people from needing a hospital visit.

"It's an integrated-care model that brings some efficiencies," said Ghita Worcester, a senior vice president with Minneapolis-based UCare. The insurer sells a health plan called Fairview UCare Choices, which is focused on the Minneapolis-based health system.

One way to spot a health plan with a narrower network is that the product's name will include the health system, although that's not always the case. Another clue: Narrower network plans this year typically come with a 7 percent to 10 percent discount on premiums.

This is the first year in Minnesota that the correlation between networks and premiums has been so clear, said Dannette Coleman, a senior vice president with Minnetonka-based Medica. Previously, very low rates in Minnesota from some carriers meant broad-network options were among the least expensive, Coleman said.

"We're starting to see some price saturation, where folks are having to make those trade-offs in order to have their premiums match their budget," she said.

This year, Medica is seeing above-average growth in three "care system products" it sold last year, Coleman said. It has added a fourth, which is focused on northwestern Minnesota.

Such health plans are attractive to people who already get care from doctors and hospitals within the network, said Donna Zimmerman, a senior vice president with Bloomington-based HealthPartners. The insurer thinks newcomers should be drawn by the plans, too, since the smaller network has a track record of providing value.

"Don't be afraid of plans that have a narrower network," Zimmerman said.

But some people feel like they've gotten burned.

In 2014, a woman complained to MNsure officials that even though she had insurance, she received bills for more than $90,000 following surgery and a week's worth of care at Abbott Northwestern Hospital in Minneapolis. The hospital wasn't in her health plan's network, according to a written summary of the complaint by MNsure.

Abbott Northwestern officials said that they couldn't comment on the case, but that it seemed highly unusual. Hospitals and insurers typically would work with patients to prevent such huge bills, said Meg Hasbrouck, the vice president of payer contracting and reimbursement Allina Health, the hospital's parent company.

The risk of some extra cost with out-of-network care certainly is part of the bargain with narrow network plans, Allina says, and patients need to understand that before signing up. The trade-off is that in-network doctors and hospitals take more responsibility for providing efficient care. "We certainly support the concept of narrow networks," said David Kanihan, an Allina spokesman, "because there's a lot of good that can come with them."

There aren't good numbers yet to show how many people are buying narrow network plans this year, but there's evidence of growth. Lett of the insurance agency in Woodbury said narrow network plans can be a good deal, but he believes agents are key to helping consumers weigh the pros and cons.

Some who bought low-premium products in December have been surprised and frustrated with network limits when trying to seek care this month, Lett said. That has prompted some to contact insurance agents about switching to plans with a broader network before the end of open enrollment.

"I now wonder, for the next 10 months or so, how many people are going to realize once they're locked in, that they're in a narrow network?"

Twitter: @chrissnowbeck

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