Want to Know Whether Your Health Plan’s Network is Narrow or Broad? You’ll Need to Wait Another Year

The Obama Administration has delayed the promised rollout of a new network size rating system on healthcare.gov. Instead of being available in all federally facilitated marketplace (FFM) states, the new network ratings will be piloted in just 6 as-yet-unnamed states.

Earlier this year, the Obama Administration announced that, for the first time, they would provide consumers with a rating for each health plan’s network size, beginning in 2017. This move was applauded by consumer advocates, who have long argued that consumers need a better 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 as insurers continue to reduce their number of contracted providers.

As outlined in the administration’s 2017 Letter to Issuers in February of this year, each health plan on healthcare.gov would receive a designation to indicate the plan’s relative network breadth. Plans would be compared to one another within each county based on the number of contracted hospitals, adult primary care and pediatricians. The plans would then be categorized in one of three ways: Basic, Standard, and Broad.

Just a few months later, however, the Administration released new guidance that delays until at least 2018 the implementation of these network ratings in all but 6 states. The guidance doesn’t provide much rationale for the retreat, but the reasons are not hard to guess. First, figuring out how to develop and display these ratings in a way that is meaningful and actionable for consumers is not easy. Beta testing on a small population of marketplace consumers makes sense before rolling the ratings out nationwide. The administration did a similar staged roll out last year with the provider and formulary look up tools; both were eventually made available to all FFM consumers. Second, I suspect that officials faced concerns from participating insurers about the accuracy of the methodology for rating their plans’ networks, as well as the potential impact of being rated “Basic” or “Broad.”

Consumers deserve to know what they’re buying. The network size rating system, even if imperfect, could help consumers enroll in a plan that better meets their needs. And when people enroll in a plan that meets their needs, they’re more likely to stay in that plan and pay their premiums. Let’s hope the administration moves forward as quickly as possible to test and deploy the network rating system.

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