Expensive plans don't mean large provider networks


The highest priced plans available on a health insurance exchange don't necessarily have the best benefits, says a new analysis from the U.S. News & World Report.

In particular, the analysis, which examined all plans sold on California's online marketplace, found expensive plans don't always go hand-in-hand with larger networks providing greater access to doctors and hospitals, U.S. News reported.

"Sometimes you just pay more" without always receiving access to more providers, Gerald Kominski, director of the UCLA Center for Health Policy Research, told U.S. News.

For example, at least one mid-priced plan offers a similar-sized provider network as the most expensive plan. But the prices differ drastically; for example, a 21-year-old nonsmoker enrolling in the most expensive plan will pay $434 more per year in premiums to receive the similarly sized provider network.

And since consumers generally link price with quality, they could unnecessarily buy more expensive plans. "I do think the average consumer thinks higher price is somehow better," a Stanford University economist, Alain Enthoven, told U.S. News. That's why the goal eventually is "to make it so easy [for consumers] to make a choice that people don't worry about the fine print."

Such confusion over provider networks is partly what led the Centers for Medicare & Medicaid Services to propose requiring insurers submit a list of providers so it can determine whether their networks provide "reasonable access" to doctors and hospitals. Last month, CMS also said it's considering calling for insurers to expand their networks to include more safety-net hospitals and other providers that low-income consumers typically use, FierceHealthPayer previously reported.

To learn more:
- read the U.S. News and World Report article
- here's the CMS letter (.pdf)

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