Marketplace Health Plans Embrace Limited-Provider Networks to Keep Premiums Affordable

Most health plans have focused on limited provider networks as one of their primary strategies for keeping premiums affordable.

The Issue

In 2014—the first year for insurance marketplace plans—some emphasized provider rate discounts, while others utilized patient-centered medical home approaches to control the total cost of care. Health plans continued to experiment with different network configurations and provider payment arrangements in their 2015 plan offerings.  

Key Findings

New efforts to control total costs of care:

  • Restricting out-of-network access

  • Adopting telemedicine and promoting wellnes

  • Keeping premiums in check by imposing substantial out-of-pocket costs

  • Offering traditional managed care tools

  • Providing alternative payment mechanisms designed to shift risk to providers

Conclusion

The key challenge ahead will be ensuring consumers have readily accessible, accurate information on providers and sufficient access to different types of providers in the health plan networks. At the same time, health plans must successfully balance these with the need to keep premiums affordable.  

About the Grantee

Mathematica Policy Research is dedicated to improving public well-being by bringing the highest standards of quality, objectivity, and excellence to bear on information collection and analysis for our partners and clients. The company has been at the forefront of assessing the effectiveness of policies and programs since 1968.