Most Regionally Ranked Hospitals Stay In-Network with Marketplace Plans, But Participation Declines

Analysis Compares Providers Accessible Through Marketplace Plans with Those Included on U.S. News & World Report's List of Best Regional Hospitals

Staff portrait of Kathy Hempstead Headshot

Katherine Hempstead, PhD, MA, director and senior program officer, leads RWJF's work on health insurance coverage.

Looking at network participation by state, nearly all highly ranked regional hospitals were in-network with at least one marketplace plan in both 2015 and 2016.

The Issue

Analysis compares providers accessible through marketplace plans with those included on U.S. News & World Report’s list of Best Regional Hospitals.

Key Findings

  • Network participation decreases significantly, however, as more than half of hospitals reduce the number of networks in which they participate between 2015 and 2016.

  • The percent of hospitals in-network with only one marketplace plan increased from 7 percent in 2015 to 20 percent in 2016.

  • Network participation declined more in metro areas.

  • Customers loyal to a particular hospital can in most cases still find a marketplace plan that includes it, but choices are narrowed in 2016 relative to 2015; plans with these hospitals may be more expensive.

Conclusion

Many consumers returning to the marketplace in 2016 may find that their choices have changed in ways that limit their access to certain providers. Yet it is still the case that almost all of these highly rated hospitals are in-network with at least one marketplace plan.