Obama administration introduces changes to health insurance rating system

The changes come in response to customer criticisms of health insurance plans available on the online exchanges

Insurance News

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Health insurance plans sold through the online exchanges established under the Affordable Care Act will now carry ratings based on the size of networks included.

According to changes published Tuesday in the Federal Register, insurance carriers will be allowed to sell health plans with narrow provider networks, but will be labeled as such on the federal HealthCare.gov exchange. Maximum out-of-pocket costs for consumers under the ACA will also increase next year to $7,150 for an individual and $14,300 for families.

The announcement comes amid consumer complaints over the limited choice of doctors and hospitals included in exchange plans – networks that were narrowed even further by some insurers in an attempt to control costs.

Yet these plans continue to sell as cost-conscious consumers elect low premiums over a greater choice of healthcare providers.

The changes should make it easier for these consumers and assisting insurance agents to reliably determine the size of a plan’s provider network and to compare it to that of other plans in the same geographic area. Previously, agents could only determine whether policies covered a specific doctor.

“This could be really helpful for a lot of consumers,” Sabrina Corlette, a consumer advocate and professor at the Health Policy Institute of Georgetown University, told the New York Times.

Narrow insurance plans have come under fire from insurance regulators, consumer groups and healthcare providers since their growth in popularity under the ACA.  The National Association of Insurance Commissioner released a model law last year that would require insurers to include enough healthcare providers for consumers to get the services they require “without unreasonable travel or delay.”

The American College of Emergency Physicians has also spoken out against the narrowness of insurance plans.

According to a new poll from the group, seven in 10 emergency physicians say their patients have delayed medical care because of excessive out-of-pocket expenses, high deductibles and high co-insurance payments. In addition, 73% of respondents say narrow networks allowed by insurers have caused disruption in necessary care, and another 67% say primary care physicians are sending patients to emergency departments to receive medical tests or procedures when health insurers refuse to cover them in an office setting.

Rural parts of the country are especially in danger of having few policy options with access to wide coverage. One study suggested that as many as 83% of plans offered in Georgia include narrow networks, and another study from Harvard suggested that 15% of plans offered through the federal marketplace did not include any doctors for at least one critical specialty.

Insurers, however, have argued that narrow networks allow consumers to save money in an environment of increasing costs. The latest rules from the White House have preserved that option.

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