Health plans to be rated on number of providers
Out-of-pocket cost caps will increase next year.
— The WASHINGTON Obama administration, responding to consumer complaints, said it would begin rating health insurance plans based on how many doctors and hospitals they include in their networks.
At the same time, the maximum out-of-pocket costs for consumers under the Affordable Care Act will increase next year to $7,150 for an individual and $14,300 for a family, the administration said. Consumer advocates said those costs could be a significant burden for middle-income people who need a substantial amount of care.
Under new rules to be published Tuesday in the Federal Register, insurers will still be allowed to sell health plans with narrow networks of providers. But consumers will know in advance what they are getting because the government will attach a label indicating the breadth of the network for each plan sold on HealthCare.gov.
About 12.7 million people signed up or had their coverage automatically renewed in the third annual open enrollment season, which ended Jan. 31.
Many health plans offered in the public marketplaces provide a limited choice of doctors and hospitals, and some insurers narrowed their networks this year by excluding some doctors and dropping popular teaching hospitals.
Consumers have grumbled about the changes, and some say they have had difficulty finding medical specialists. But cost-conscious consumers have gravitated to these plans because they tend to offer lower premiums than health plans providing a greater choice of doctors and hospitals.
Consumers can already find out which health plans include a specific doctor. But until now they had no reliable way to determine if a health plan had a large or small network of providers. The new ratings will indicate how the breadth of a health plan’s network compares with that of other plans in the same geographic area.
“This could be really helpful for a lot of consumers,” said Sabrina Corlette, a consumer advocate and professor at the Health Policy Institute of Georgetown University.