A study by health-plan ranking and comparison company HealthPocket found that 53 percent of HealthCare.gov exchange plans offer out-of-network coverage, with the rest without out-of-network coverage except in medical emergencies or when providers and/or patients health plan formally ask for out-of-network care and the request is approved.
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 from 0 percent in South Dakota to 100 percent in Alaska, Alabama, Louisiana, Tennessee and West Virginia. In 13 states, fewer than half of the plans offered out-of-network coverage.
No wonder many providers and patients don’t like such “narrow networks”.
“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.