A new study from the University of Pennsylvania’s Leonard David Institute of Health Economics found that an insurance plan type does not correspond with network size. This is the first study to examine physician participation in insurance exchange plan networks. On average, plans with less than 10% of a plan’s regional physicians were considered “extra small” and made up 11% of total plans. “Small” plans represented 30% of plans and covered between 10-25% of physicians in the plan’s region. Only 11% of plans were categorized as “extra-large”, covering at least 60% of physicians in the area.
There is a clear trade-off between premium price and network size as consumers shop for coverage in the insurance exchanges. Under the health law, health plans have to “maintain a network that is sufficient in number and types of providers … to assure that all services will be accessible to enrollees without unreasonable delay.” The study also found that preferred provider organizations (PPOs) and health maintenance organizations (HMOs) made up 80% of plans offered on the marketplace. HMOs usually do not cover out-of-network providers, however more than half of HMO physician networks were small or very small. On the other hand, PPOs do cover out-of-network providers and only a quarter of them had physician networks that were classified as either small or very small. These direct-to-consumer markets need to be ready to address these issues as more consumers enter the market and demand for care increases.
Written by Alison Killian
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Alison Killian is a recent graduate of Grove City College who majored in Business Management and minored in Biology Studies. She is a contributor to Medical Groups and passionate about all facets of healthcare. She plans on continuing work in the healthcare field especially in management. She is very interested in healthcare innovation and finding ways to improve the current system. She hopes to go back to school in a few years to earn a degree in medicine.