PPACA Exchange Plans Offer Less Choice of Doctors Than Commercial Plans


Summary: The only way insurance companies can compete for business on the PPACA exchange is through lower rates. That is accomplished by paying providers less. Benefit design is mandated and therefore not a differentiator in plan selection.

MONDAY, JULY 20, 2015 – BenefitRevolution Blog

Study: PPACA Exchange Plans Offer 66% of the Doctors of Standard Commercial Plans

One of the largest complaints associated with Obamacare plans has been the lack of physician availability. Avalere Health has helped to quantify this in a recentĀ study:

  • The average provider networks for plans offered on the health insurance exchanges created by the Affordable Care Act (ACA) include 34 percent fewer providers than the average commercial plan offered outside the exchange.
  • Exchange plan networks include 42 percent fewer oncology and cardiology specialists; 32 percent fewer mental health and primary care providers; and 24 percent fewer hospitals. Importantly, care provided by out-of-network providers does not count toward the out-of-pocket limits put in place by the ACA.

Download PDF of study.