Most ACA Marketplace Enrollees Are in Narrow Network Plans

Most people enrolled in Affordable Care Act exchange plans had in-network access to fewer than half of clinicians in their area in 2021, according to a KFF study published on Aug. 26. Matthew Rae, the report’s lead author, tells AIS Health the number of physicians in networks varies widely even within states and counties, yet it is still difficult for consumers to compare and choose plans.  

Rae adds that insurers often limit their exchange networks to keep their costs down and competitive in a crowded field, where often dozens of plans vie for enrollees. He points out that insurers seek to price their offerings based on the second-lowest cost plan in the marketplace’s silver category, which is linked to the premium tax credits that most enrollees receive. Plans that are more expensive than the second-lowest cost silver option often only get a small number of enrollees, according to Rae.