A large number of insurance plans sold in the Obamacare marketplaces significantly limit the doctors and hospitals patients can visit, a new study finds.
Four in 10 mid-grade “silver” plans on the exchanges had narrow provider networks in which fewer than 25 percent of doctors in the area are covered, according to research funded by the Robert Wood Johnson Foundation.
Customers buying coverage through the marketplaces have complained of their plans’ strict limitations on the providers they can see, but the study released Wednesday is among the first documenting the extent to which plans restrict provider networks.
The study likely will provide Republicans with more ammunition against the Affordable Care Act, as they argue that even though more people have insurance under the law, the coverage doesn’t guarantee access to the doctor they want to see and might still be too expensive. A House panel is holding a hearing Wednesday morning focused on the price of premiums in the Obamacare marketplaces.
Researchers found that 11 percent of the plans cover fewer than 10 percent of physicians in the plan region. Another 30 percent cover between 10 and 25 percent of doctors in the area. Network size also varied by the type of physician: 36 percent of primary care networks were small compared with 23 percent for internal medicine subspecialties and 59 percent for oncology.
“Provider network size and composition has become an important part of how insurers price marketplace plans and attract consumers, but so far, consumers do not have usable information about provider networks,” said Kathy Hempstead of the Robert Wood Johnson Foundation.
