By Justin Giovannelli, Kevin Lucia, and Sabrina Corlette
Health insurance plans with limited networks of providers are common on the Affordable Care Act’s (ACA) health insurance marketplaces. The ACA’s consumer protections, along with online marketplace platforms that encourage insurers to compete on price, have led to a trend in health plan design that combines a comparatively low premium with a more restricted choice of providers.
These “narrow network” plans offer value to consumers and encourage more efficient delivery of care, but these plans also pose risks; a network can be too narrow, jeopardizing the ability of consumers to obtain needed services in a timely manner. Limited networks also have the potential to expose enrollees to significant expenses and the possibility of surprise medical bills. In response to these potential risks, lawmakers and regulators have devoted significant attention to network regulation, to ensure that coverage is adequate and transparent.
In a recent policy brief published by Health Affairs and supported by the Commonwealth Fund, Justin Giovannelli, Kevin Lucia, and Sabrina Corlette offer an overview of state and federal actions that address network standards and provider directories, with a focus on rules that govern plans sold on the ACA’s health insurance marketplaces.
You can read the full brief here.