Number of narrow-network plans varies widely by state
As narrow networks tied to the Affordable Care Act continue to be a hot topic of debate, a new report highlights where in the country these controversial plans are most common.
The report, produced by researchers at the University of Pennsylvania's Leonard Davis Institute with funding from the Robert Wood Johnson Foundation, categorized the network size of health plans on marketplace exchanges by five groups named for T-shirt sizes--x-small, small, medium, large and x-large--based on the fraction of providers that participate in the network.
Their analysis reveals that four states have the highest percentage of narrow (x-small or small) network plans: Georgia, Florida, Oklahoma and California. In these states, at least 75 percent of marketplace plans have narrow networks that cover 25 percent or fewer of all area physicians.
Still, "although the concept of narrow networks has gained national attention, it is important to note that we could find no narrow ones in 12 states," the report states. Some states, such as Delaware, Kansas and North Dakota, feature mostly large or x-large networks.
Anthem, Cigna and Blue Shield of California have all come under fire after some claimed they provided misleading information to consumers regarding their provider networks, FierceHealthPayer has reported.
As for what causes some states to offer far more narrow-network plans than others, the researchers write that there is no definitive answer--though they note a strong correlation between states that offer more HMO plans and those that have more narrow-network plans.
Furthermore, new regulations that require provider directories to be more comprehensive and user-friendly will help consumers evaluate the implications of choosing narrow-network plans, an increasingly popular choice for the cost-conscious.
"Well-functioning narrow networks will survive only if they are made more transparent to consumers and are regulated to ensure sufficient network adequacy," according to the report.
To learn more:
- here's the report
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