The data quantifies anecdotal reports that exchange networks contain fewer providers.
Avalere’s analysis broke down the number of physicians available on exchange plans compared to commercial plans. Exchange plan networks include 42 percent fewer oncology and cardiology specialists, 32 percent fewer mental health and primary care providers and 24 percent fewer hospitals. Notably, care provided by out-of-network providers does not count toward the out-of-pocket limits established by the ACA.
Avalere examined the largest rating region in the top five states for effectuated enrollment in the exchanges in 2015: Florida, California, Texas, Georgia and North Carolina. In each of these regions, Avalere compared the average number of providers included, for each of the five provider types examined, in exchange networks compared to commercial networks in the same geographic area.
“Patients should evaluate a plan’s provider network when picking insurance on the exchange,” said Elizabeth Carpenter, vice president at Avalere. “Out-of-network care does not accrue toward out-of-pocket maximums, leaving consumers vulnerable to high costs if they seek care from a provider not included in their plan’s network.”
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