Will ACA network ratings affect how consumers buy health plans?


The federal government is taking a stab at making health insurance plans easier to understand, compare and purchase on the government exchange by ranking health plans by network size. But will the change affect the consumer purchasing penchant for high deductible, low coverage policies?

As part of rules released March 1, federal officials will begin rating health insurance plans under the Affordable Care Act based on how many physicians and hospitals are included in their network. Each plan will receive a size designation roughly equivalent to basic, standard and broad.

Differentiating plans by network size is a clear attempt to help consumers understand the kind of coverage they are buying. Under increasingly narrow provider networks, many consumers have reported being surprised by out-of-network medical bills for services they believed were covered by insurance.

But federal attempts to protect consumers may fall short without a corresponding change in how insurance companies educate their consumers, says Jay Kaplan, MD, president of the American College of Emergency Physicians.

"As one health insurance company vice president said on a panel at a recent American Medical Association conference, 'the first and only thing which people look at is the affordability of the premium,'" says Dr. Kaplan.  

Without substantive change in how consumers understand what is adequate and necessary coverage, Dr. Kaplan believes a large majority of consumers will continue to base insurance decisions on premiums, without much regard to network ratings.

Many payers have increasingly narrowed network coverage as a way to control costs and improve margins. Thereby many payers lack the incentive to educate their consumers as to what constitutes an adequate network size, says Dr. Kaplan.

Until payers and providers can arrive at an understanding of what acceptable network coverage looks like, and build plans that reflect it, patients are in danger of continuing to to purchase health plans without a full understanding of what their coverage entails.

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