The Ever-Shrinking Pilot to Inform Consumers About Health Plans’ Network Size

Consumers in just four states will have access to information about the relative size of health plans’ provider networks offered via the federal health insurance marketplace. And it’s not clear when that will be. Guidance released on September 30 by the Center for Consumer Information & Insurance Oversight (CCIIO), which runs the federally facilitated marketplace (FFM), indicates that “at some point” during the coming open enrollment season, network breadth information will be displayed in Maine, Ohio, Tennessee and Texas.

As we noted previously here on CHIRblog, CCIIO committed to piloting the network size rating system in six states back in August, which was a significant reduction from the anticipated rollout of the system in all 34 states using the federal marketplace platform. In just a few short months, CCIIO has shrunk the availability of the network size rating tool from 34 states, to six, and now to four.

Consumer advocates had initially applauded the initiative to rate plans based on their network size. Many have argued that consumers need a way to assess how many hospitals and doctors are included in the marketplace health plans. The new rating system was also an acknowledgment that traditional plan labels – “HMO” (Health Maintenance Organization) and “PPO” (Preferred Provider Organization) – are no longer accurate indicators of a plan’s network size, particularly as insurers continue to reduce their number of contracted providers.

Unfortunately, it now appears that a network size rating system available across the FFM during the next open enrollment season was too ambitious an undertaking, either because of capacity limitations, push back from insurers, or both. Thus we are now down to four states from which CCIIO will collect data on consumer experiences with the network breadth rating tool. This data will be used to inform the display of network information in future years, which hopefully will be available for all marketplace shoppers, no matter what state they live in.

6 thoughts on “The Ever-Shrinking Pilot to Inform Consumers About Health Plans’ Network Size

  1. Years ago i tried to find a unit cost of health insurance. What is the cost per beneficiary, per patient, or the marginal cost. This information which any consumer gets every day for any product they want to purchase, is not available to the public. I asked the Maryland State Insurance Commission for it and was told even they do not have it. Such insurance industry greed is what keeps premiums high, has millions of dollars rolling into the executive pockets, and is in direct contradiction to a capitalist market. This information would be much more useful than the size of a plan.

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