Lewis & Ellis Inc.

Consumers face narrower care networks on health insurance

Health Care and Health Insurance
by Sergei Mordovin
Special ACA enrollment period seeing early success
Special ACA enrollment period seeing early success

The health insurance landscape has changed markedly since the passage of the Patient Protection and Affordable Care Act several years ago, and those alterations to the coverage people have faced for decades continue to happen even now. One of the biggest things that may end up impacting people is the fact that insurers are slowly but steadily narrowing the number of in-network health care providers for a given plan.

Today, 60 percent of health insurance networks covering people in major U.S. cities have narrowed in some way, and 48 percent have done so overall, according to U.S. News and World Report. This has come largely as health insurers look to cut costs in the face of rising regulatory controls and a growing number of people - some of whom might have preexisting conditions - getting enrolled in such coverage over the last few years.

What does this mean for patients?
It is important to note that narrow networks have existed for quite some time, typically as part of HMOs.  However, consumer backlash in the late 1980s and early 1990s caused the lawmakers to consider putting standards in place to make sure that the number of options for consumers was as large as possible, the report said. But the big comeback seen in the last few years, since the ACA was passed, has been met with far less backlash from either consumers or legislators.

Insurance companies will highlight the fact that narrower networks generally reduce monthly premiums for consumers, the report said. However, 51 percent of consumers in a recent poll said that they would pay a little more every month if it meant having access to a broader network. Likewise, only 37 percent of respondents said they would seek out a smaller network if it meant paying less. And if such a change meant they had to change doctors, only 23 percent would make the switch.

Therefore, insurance companies may need to seek creative ways to make sure their concerns about rising costs match up with the consumers' concerns about narrowing networks and higher premiums. The more that can be done in this regard to find judicious solutions, the better off policy providers are likely to be when it comes to meeting people's expectations, as well as their own.



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