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Nearly 15% of insurance plans for sale via healthcare.gov lack in-network physicians for at least one specialty, according to an analysis published Oct. 27 in JAMA. Endocrinologists, rheumatologists, and psychiatrists were most commonly excluded.
Stephen C. Dorner of Harvard T. H. Chan School of Public Health, Boston, and his colleagues examined physician networks in 34 states offering plans through the federal marketplace (healthcare.gov) during 2015 open enrollment. They searched plans’ online directories for in-network specialists in obstetrics/gynecology, dermatology, cardiology, psychiatry, oncology, neurology, endocrinology, rheumatology, and pulmonology. Searches were done for specialists within both 50 and 100 miles.
Of the 135 plans, 18 (13%) were specialist deficient in the 100-mile search, while 19 (14%) of plans lacked in-network specialists in the 50-mile search (JAMA. 2015;16:1749-50. doi. 101001/jama.2015.9375).
Patients in specialist-deficient plans had high out-of-network costs, Mr. Dorner and colleagues found. Of the 19 specialist-deficient plans, 5 did not cover out-of-network services, whereas 11 of the remaining 14 plans required cost-sharing of 50% or more. Nine of the 19 inadequate plans did not cover medications prescribed by out-of-network physicians.
The findings raise concerns about patient access to specialty care and suggest that a number of plans are violating network adequacy requirements, Mr. Dorner said, adding that such inadequate plans precipitate high out-of-pocket costs and may lead to adverse plan selection.
On Twitter @legal_med
Nearly 15% of insurance plans for sale via healthcare.gov lack in-network physicians for at least one specialty, according to an analysis published Oct. 27 in JAMA. Endocrinologists, rheumatologists, and psychiatrists were most commonly excluded.
Stephen C. Dorner of Harvard T. H. Chan School of Public Health, Boston, and his colleagues examined physician networks in 34 states offering plans through the federal marketplace (healthcare.gov) during 2015 open enrollment. They searched plans’ online directories for in-network specialists in obstetrics/gynecology, dermatology, cardiology, psychiatry, oncology, neurology, endocrinology, rheumatology, and pulmonology. Searches were done for specialists within both 50 and 100 miles.
Of the 135 plans, 18 (13%) were specialist deficient in the 100-mile search, while 19 (14%) of plans lacked in-network specialists in the 50-mile search (JAMA. 2015;16:1749-50. doi. 101001/jama.2015.9375).
Patients in specialist-deficient plans had high out-of-network costs, Mr. Dorner and colleagues found. Of the 19 specialist-deficient plans, 5 did not cover out-of-network services, whereas 11 of the remaining 14 plans required cost-sharing of 50% or more. Nine of the 19 inadequate plans did not cover medications prescribed by out-of-network physicians.
The findings raise concerns about patient access to specialty care and suggest that a number of plans are violating network adequacy requirements, Mr. Dorner said, adding that such inadequate plans precipitate high out-of-pocket costs and may lead to adverse plan selection.
On Twitter @legal_med
Nearly 15% of insurance plans for sale via healthcare.gov lack in-network physicians for at least one specialty, according to an analysis published Oct. 27 in JAMA. Endocrinologists, rheumatologists, and psychiatrists were most commonly excluded.
Stephen C. Dorner of Harvard T. H. Chan School of Public Health, Boston, and his colleagues examined physician networks in 34 states offering plans through the federal marketplace (healthcare.gov) during 2015 open enrollment. They searched plans’ online directories for in-network specialists in obstetrics/gynecology, dermatology, cardiology, psychiatry, oncology, neurology, endocrinology, rheumatology, and pulmonology. Searches were done for specialists within both 50 and 100 miles.
Of the 135 plans, 18 (13%) were specialist deficient in the 100-mile search, while 19 (14%) of plans lacked in-network specialists in the 50-mile search (JAMA. 2015;16:1749-50. doi. 101001/jama.2015.9375).
Patients in specialist-deficient plans had high out-of-network costs, Mr. Dorner and colleagues found. Of the 19 specialist-deficient plans, 5 did not cover out-of-network services, whereas 11 of the remaining 14 plans required cost-sharing of 50% or more. Nine of the 19 inadequate plans did not cover medications prescribed by out-of-network physicians.
The findings raise concerns about patient access to specialty care and suggest that a number of plans are violating network adequacy requirements, Mr. Dorner said, adding that such inadequate plans precipitate high out-of-pocket costs and may lead to adverse plan selection.
On Twitter @legal_med
FROM JAMA
Key clinical point: Many patients who buy insurance via healthcare.gov are not getting access to specialists’ care.
Major finding: In a study of 135 federal marketplace insurance plans, nearly 15% lacked in-network physicians for at least one specialty. Of 34 states, 9 had at least one specialist-deficient plan.
Data source: Review of physician networks listed on insurance plans for sale via healthcare.gov in April 2015.
Disclosures: No relevant financial disclosures were reported.
