Study: Nearly half of ACA plans don't offer easy access to out-of-network care

Almost half of insurance plans on the Affordable Care Act's federal marketplace don't make it easy for members to access out-of-network coverage, according to a new study.

The study, conducted by health plan ranking and comparison company HealthPocket, found that 53 percent of ACA plans on the HealthCare.gov exchange do offer out-of-network coverage. But the rest lack out-of-network coverage except in medical emergencies or instances where the health plan is formally petitioned for out-of-network care and approves the request.

The study also looked at data on individual and family plans in the 37 states that provide coverage through the federal marketplace. The percentage of plans offering out-of-network coverage in each state varied ranging from 0 percent in South Dakota to 100 percent in Alaska, Alabama, Louisiana, Tennessee and West Virginia, the study found. In 13 states, fewer than half of the plans offered out-of-network coverage.

One of the primary consumer complaints about many ACA health plans is that their provider networks are too narrow, HealthPocket notes.

In fact, many Americans are getting hit with surprise bills from their insurance carriers when they seek care outside of approved networks, FierceHealthFinance previously reported. However, some argue that narrow networks may be a useful cost-cutting tool, and one report indicates that consumers may be increasingly willing to trade choice and access for price when choosing plans.

"What is unclear at the present time is whether more Affordable Care Act insurers will be able to offer new plans in the future that achieve the price point necessary in the individual health insurance market while satisfying consumer concerns over network breadth and coverage of out-of-network care," the study says.

To learn more:
- read the study

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