‘Narrow networks’ that limit choice likely to endure on individual market
When regulators release 2018 health plan details on Monday, indications are that the market will have settled down significantly, with relatively moderate premium increases and a steady lineup of insurers.
But when it comes to networks -- the list of doctors and hospitals that subscribers can visit with the smallest out-of-pocket costs -- the limitations that have vexed consumers are likely to endure, albeit with some changes.
"I don't expect the old networks that include almost all doctors and hospitals to come back anytime soon, because that doesn't work to hold down premiums," said
Health plans that include what are called "narrow networks" have emerged as a prominent cost-control tool for insurers in individual markets, a small slice of the health insurance world that primarily covers people under age 65 who are self-employed or don't receive job-based benefits.
In
Insurers can make exceptions, but the network rules generally steer patients toward one health care system near where they live, such as Allina for shoppers in
In 2018, a new
"As big a hassle as it is to drive to
There's no set definition for what constitutes a narrow network health plan. All insurance policies sold under the ACA are regulated to make sure they meet standards for what's called "network adequacy," yet complaints persist.
Consumers with the coverage are free to obtain out-of-network care, but they might be asked to pay thousands of dollars, or even tens of thousands, more for the privilege.
Compared with much of the nation,
They defined networks as narrow when the ratio of in-network physicians to the total number of eligible doctors in the area is less than 25 percent; they found only nine states had a greater share of narrow plans than
Narrow networks aren't all bad, said
Beyond the premium savings, though, consumers don't typically prefer the plans because "they limit choice of providers and carry greater risks of being saddled with an out-of-network bill," Polsky said via e-mail. "This can be particularly problematic for patients seeking very specialized care because there may not be adequate in-network choices available."
In
'Held on as long as we could'
"There was no competition for open-access plans," Keefer said. "My position would be, we held on as long as we could [as] an outlier in the market."
Insurers have long suggested the
As the argument over payment rates at Mayo continues, insurers for the first time in 2018 will operate under a new law that requires them to offer at least one individual health plan with a provider network that includes in-network access to more than one health care provider system. The requirement builds on existing rules assuring patients have access to primary care providers within either 30 miles or 30 minutes, and 60 miles or 60 minutes for specialists.
The hope was to make sure that consumers in greater
"I think it will make a marginal difference," Benson said.
But Sen.
"People are still feeling a lot of pain with networks," said
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