Most exchange plans limit member choices


Health insurance plans sold through state health insurance exchanges are likely to include limited choices of doctors and hospitals and require referrals for specialists and preauthorization before expensive procedures, The Wall Street Journal reported.

The paper cited a McKinsey & Co. analysis that found 47 percent of 955 plans proposed for the insurance marketplaces early in the filing period were for health maintenance organizations (HMOs) or plans with similar designs. Other plans classified as preferred provider organizations (PPOs) also would restrict patient choice of doctors and hospitals.

Insurers interviewed for the article said they believe cost-conscious consumers shopping in the online marketplace will accept the tradeoff of less choice for lower premiums.

"Individuals are making a lot of choices based on cost, particularly because it's coming out of their pockets," Steve Hamman, a vice president at Blue Cross and Blue Shield of Illinois, told the newspaper.

By offering plans with smaller provider networks, the company can offer premiums 20 percent to 30 percent lower than its other plans, he said.

In some cases, insurers are partnering with healthcare providers to create narrow network plans targeted toward patients with certain chronic conditions.

For example, Blue Cross Blue Shield of Minnesota and Allina Health are creating a plan aimed at patients with diabetes, hypertension and high cholesterol. The BluePrint plan provides two or three free office visits and full coverage for drugs and lab tests, often without co-pays. Premiums are lower than traditional plans, but coverage is limited to Allina hospitals and medical practices.

For more information:
- read the WSJ article

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