08/26/2024 | Press release | Distributed by Public on 08/26/2024 06:30
A KFF analysis of physician networks in the Affordable Care Act's Marketplace plans finds wide variations in the share of local practicing physicians who participate, with the least costly plans generally having a smaller share of physicians than more expensive plans.
The analysis examines the breadth of physician networks listed in Marketplace plan directories in 2021 in nearly every county nationally in relation to the number of actively practicing physicians locally.
On average, Marketplace enrollees had access to 40% of practicing physicians in their area in 2021, with wide variations across plans. For instance, 23% of enrollees were in plans with no more than a quarter of local doctors, while only 4% were in plans with at least three-quarters of local doctors.
Plans with networks that include a larger share of local physicians typically have higher premiums. For example, Marketplace silver plans with at least half of local participating doctors in their networks on average cost 8% more than plans with less than a quarter of participating doctors on average.
This can lead to savings for consumers comfortable with a narrower doctor network, but higher costs for enrollees who want access to plans with a broader network. For example, in counties where the two lowest cost plans have narrower networks (up to a quarter of doctors) but one with a broader network is offered (at least half of doctors), it would cost $95 extra per month to enroll in the broader network plan.
The breadth of a plan's network can be a factor in enrollees' ability to access care. A 2023 KFF survey found that one in five consumers enrolled in Marketplace plans said that a provider they needed was not covered by their insurance, more than the share with employer coverage who say so.
Other findings include:
For consumers, assessing the breadth of Marketplace plans' networks when choosing a plan can be extremely difficult. In 2021, for example, enrollees on average had a choice of 58 different plans in their county, including variations offered by the same insurer with different provider networks, with no overall way to measure the breadth of each option's network. In addition, not all providers listed in a plan's network will be open to taking new patients, further narrowing options for some consumers.
The analysis also examines how much choice consumers have in the breadth of the networks in their county where they live, variations within and across geographic areas, and differences across plan insurers.