Most marketplace plans included at least 25 percent of local-area physicians, but enrollment disparities remained

Aditi P Sen, Lena M. Chen, Donald F. Cox, Arnold M. Epstein

Research output: Contribution to journalArticle

Abstract

The Affordable Care Act allows commercial insurers participating in the Marketplaces to vary the size of their provider networks as long as the providers are "sufficient" in numbers and types. Concerns have been growing over the increasing use of restricted-provider or narrow networks in Marketplace plans because of their implications for reduced access to care, but little is known about the breadth and stability of these networks over time or what types of enrollees choose such plans. Using national data, we found that in 2016, 60 percent of provider networks in plans offered in the federally facilitated Marketplaces included at least one-quarter of local-area physicians, and that consumers' access to broad-network plans remained stable between 2015 and 2016. Hispanic and low-income people made up a disproportionate share of enrollees in smaller-network plans (those with fewer than one-quarter of local-area physicians). It will be important to monitor the impact of narrow networks on access to and quality of care as well as on health outcomes.

Original languageEnglish (US)
Pages (from-to)1615-1623
Number of pages9
JournalHealth Affairs
Volume36
Issue number9
DOIs
StatePublished - Sep 1 2017

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ASJC Scopus subject areas

  • Health Policy

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