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Narrow Networks Vary by State Marketplaces

The occurrence of narrow health plan networks in the health insurance marketplaces (exchanges) varied by state in 2014, according to a recent study by the University of Pennsylvania’s Leonard Davis Institute of Health Economics. The study identified physician networks as narrow if they included less than 25 percent of providers in a given geographical area. The study found that 10 states had a high prevalence of networks that were considered narrow, meaning 60 percent of the plans offered through their marketplaces met the narrow network threshold. Twelve states did not have any networks that were considered narrow. Narrow networks may lead to patients paying higher out-of-pocket costs to see their regular providers if these providers are established as out-of-network.

The study also found that the 10 states with high rates of narrow networks were more likely to have plans through health maintenance organizations (HMOs), while the states with low rates of narrow networks had high rates of preferred provider organizations (PPOs).

Contact Beth Feldpush, DrPH, senior vice president of policy and advocacy, at bfeldpush@essentialhospitals.org or 202.585.0111 with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.