Exchange plans cover more leading cancer centers than expected

Insurers have included prominent cancer centers in their health insurance exchange plans more often than initially estimated, according to a new survey from Avalere Health.

Avalere determined that 75 percent of the 20 cancer centers it surveyed said they're covered by at least some of the exchange plans offered by most insurers in their state. Of those cancer centers, 13 percent said they're covered by all the exchange plans in their state.

"Coverage of leading cancer centers in exchange plan networks appears better than what has been anecdotally reported," Avalere Director Sung Hee Choe said in the survey.

However, insurers continue to omit 25 percent of nationally recognized cancer centers, which means "there are geographic pockets where access may be an issue," Choe added. 

Additionally, 50 percent of the cancer centers said many exchange plans have tiered provider networks, with most falling in the higher tiers only. That means individuals who choose to receive care at those centers would have higher cost-sharing responsibilities.

Avalere also found that exchange plans' reimbursement rates for the surveyed cancer centers are generally in line or just below contracts with private insurers. Plus, the fees are higher than Medicare and Medicaid rates.

"The findings challenge current market assumptions about the exclusion of prominent medical centers from exchange plans," Avalere Senior Vice President Caroline Pearson said. "As plans continue to assess and refine their network designs it will be important to ensure that access is a key facet of the program."

As of late, exchange plans have been widely criticized for not incorporating leading providers in their networks. Last year, the Associated Press surveyed 23 nationally recognized comprehensive cancer centers and found that insurers' exchange plans excluded some of the nation's best cancer hospitals, FierceHealthPayer previously reported.

To learn more:
- here's the Avalere survey