The incredible shrinking provider network is nothing new in marketplace plans. One way insurers have kept premiums in check on the individual market is by reducing the number of providers available in a plan鈥檚 network. Earlier this year, the federal government that it would introduce a tool this fall to help consumers who are shopping on gauge how narrow a plan鈥檚 provider network is compared with聽others in the area.
But most consumers who want that information will have to wait at least another year. The Department of Health and Human Services recently that the pilot project to test the network breadth tool just got a little, well, narrower.
Consumers can already check whether specific doctors or hospitals are included in a marketplace plan鈥檚 provider network on .聽But there鈥檚 currently no way to easily measure聽the breadth of a plan鈥檚 provider network. This can be an important factor for some consumers, especially given the with no out-of-network benefits.
The new tool will designate marketplace health plan networks as 鈥渂asic,鈥� 鈥渟tandard鈥� or 鈥渂road鈥� based on how they compare with聽other health plan networks in a county. The label will reflect the availability of three types of providers: primary care, pediatricians and hospitals.
Originally, network-breadth information was going to be available for聽the on , the federally facilitated marketplace. But in August HHS it would聽make the tool available in just six unnamed states.
In September, HHS it would shrink the pilot still further, to four states 鈥� Maine, Ohio, Tennessee and Texas.
The information will be available sometime during the open-enrollment period for 2017 coverage that runs from Nov. 1 until Jan. 31, 2017.
The government will consider expanding the pilot to additional states and聽types of providers in future years, the notice said.
In 2015, an by the management consultant firm McKinsey &聽Company found that 55 percent of hospital networks for marketplace plans were broad, meaning more than 70 percent of hospitals in a specified area participated.
The new tool will designate marketplace health plan networks as 鈥渂asic,鈥� 鈥渟tandard鈥� or 鈥渂road.鈥� (iStock)
Twenty-two percent of networks were classified as narrow, defined as those in which 31 to 70 percent of hospitals participated, and 17 percent were labeled ultra-narrow, meaning 30 percent or less participated.
Labels like 鈥渉ealth maintenance organization鈥� and 鈥減referred-provider organization鈥� aren鈥檛 necessarily meaningful in communicating whether a network is broad or narrow anymore, said Sabrina Corlette, research professor at Georgetown University鈥檚 Center on Health Insurance Reforms who has about the network breadth pilot project.
Although the tool will let people compare networks in their area, still, 鈥渋t鈥檚 all relative,鈥� Corlette said. 鈥淚f you鈥檝e got a market where every single network is narrow, this network breadth rating is less useful.鈥�
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