Source: Health Policy Institute of Ohio
Consumers who bought insurance on health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage, according to an analysis released on July 15 (Source: Report: ACA Plans Have a Third Fewer Providers than Employer-Based Plans, Washington Post, July 15, 2015).
According to the study by consulting firm Avalere Health, exchange plan networks include 42% fewer oncology and cardiology specialists; 32% fewer mental health and primary care providers; and 24% fewer hospitals.
In these narrow networks, health plans negotiate contracts with a select number of providers who agree to be reimbursed at lower rates. That means the insurers can set their premiums lower, at least theoretically. But, depending on the plans design, consumers typically pay more, and sometimes much more, if they use a doctor or hospital outside the network.
Care provided by out-of-network providers does not count toward the out-of-pocket limits put in place by the Affordable Care Act.