Health insurance Your Coverage Options

The price you pay for a narrow network

Written by Diane Archer

These days, choosing a health plan that saves you money is a bit like throwing a dart.  If you have commercial insurance or a Medicare Advantage plan, you can know the monthly premium and the deductible. And, you can keep those costs down, a top priority for many people, if you choose a plan with a narrow network. But, at what price?

Regardless of whether the plan you choose has a large or small network, if it has little or no out-of-network coverage, you limit your access to care and take a risk. You could pay a lot out-of-pocket if you get diagnosed with cancer or hit by a car. The copays are hard enough to predict and can add up to serious money. But doctors and hospital care could cost you tens of thousands of dollars more if you feel you need to go out of network and do not get in-network care.

Most people opt to keep their up-front costs down and to keep their current doctor when choosing a health plan. And, they often don’t think about whether the best hospitals are in the network. Perhaps, that’s a gamble worth taking. A recent study of people enrolled in narrow network California health plans found that “access and quality did not differ significantly” among plans in a given region.

A larger plan network does not assure you get to use the doctors in that network. Even if doctors are in the plan network, they might not be taking new patients or might have a wait for an appointment beyond what is reasonable for your needs.  The real question is whether the network has top doctors and hospitals and whether you will have access to them if needed. And, that’s generally hard to know.

So, are you buying better hospital quality if you pay more in premiums? The study of California health plans found only a “modest relationship” between health plan premiums and hospital quality. But, this is one study and results will differ by region and by health plans. You can get a better understanding of the risks you take with network health plans, along with your protections if you have Medicare, here.

Here’s more information from Just Care on choosing a health plan:

 

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1 Comment

  • Because of the Affordable Care Act, people choose the lowest premium and they are struggling to pay the premium and they still can’t afford to go to the doctor because the deductible is too high.

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