Narrow networks are essentially like HMOs, in which only certain hospitals and doctors are included as in-network providers. Consumers, in exchange for fewer choices, are hypothetically supposed to pay lower monthly premiums. These plans have irked some hospitals that have been left out. Seattle Children's Hospital actually sued two health plans last year that didn't include it in their networks.
Health insurers still must adhere to requirements under the Patient Protection and Affordable Care Act that their provider networks be adequate for consumers. And so far, consumers have not complained much about the narrow networks that have been offered.
Researchers examined silver-tier exchange plans in six cities: Denver, New York, Baltimore, Portland, Ore., Providence, R.I., and Richmond, Va. They looked at insurers' websites to see which hospitals were included in each of the different plans, including narrow networks and broader PPO plans. They defined a top hospital as one that was nationally ranked by U.S. News & World Report in 2013. (It's worth noting there are a plethora of hospital rankings and methodologies, making the process imperfect.)
Of the 40 health plans studied, all but one had at least one top hospital as an in-network provider. Additionally, a majority of the plans included a higher-cost academic medical center.
However, some narrow-network plans had higher premiums than those with broader networks. Kaiser's HMO plan in Baltimore, for example, includes only two of 12 top hospitals in the area and has monthly premiums ranging from $221 to $233. But a Blue Cross and Blue Shield PPO plan has seven of 12 top hospitals and a $197 monthly premium, according to the study.
“Some consumers may want to choose the cheapest plan, while others may want to choose a plan based on access to a particular provider,” said Katherine Hempstead, a health insurance policy director at the Robert Wood Johnson Foundation, in a statement. “We need a marketplace where all of those choices are possible.”
While researchers had the time to collect these results, consumers shopping for coverage plans might not have the same luxury. Researchers said because each health insurer's website is different, “there is not a straightforward way to compare plans' networks directly.”
“Future improvements to state-based and federally facilitated marketplace websites should better enable consumers to view the size and quality of each plan's network,” the report stated.
Follow Bob Herman on Twitter: @MHbherman
