Accurate health plan provider directories are critical to ensuring that coverage works for consumers. Health plans and policymakers can take steps to reduce the prevalence of inaccuracies in provider directories.
By partnering with health insurance companies, enrollment assisters gain access to plan information and health literacy resources. Assisters can more easily obtain answers to consumer questions about the marketplace plans available to them and troubleshoot consumer problems.
When health plans design their provider networks, they need to ensure that these networks are adequate and provide meaningful access to care. The Affordable Care Act established the first-ever federal rights guaranteeing private insurance consumers access to adequate networks.
Much like a cell phone, an insurance plan is only as good as its network. Protections enacted at the federal and state levels are an important step toward strengthening private insurance provider networks. The Affordable Care Act created the first-ever provider network protections for private insurance consumers. These protections require health insurance marketplace plans to have adequate networks to meet their enrollees’ medical needs in a timely manner.
What makes up an “adequate” network of health care providers for consumers from diverse racial and ethnic groups? Our new brief describes policies to help achieve such networks—and strategies to put these policies in place.
Quality, Not Size: How to Ensure Health Insurance Marketplace Plans Have Adequate Provider Networks for Consumers
For many years prior to the Affordable Care Act, we’ve encountered stories from consumers who have trouble finding health care providers who are in their insurance company’s network or who can’t get accurate information about which providers are in their network. Now, provider network issues are more contentious than ever.
Health insurers and web brokers who follow certain federal rules (relating to topics such as protecting consumer information and displaying standardized disclaimers) are allowed to directly enroll consumers in marketplace health coverage and financial assistance; the consumer does not need to directly visit a marketplace website or contact a marketplace call center in these instances.
As we move into the last two months of the open enrollment period, government officials and advocates are thinking about how to better reach consumers and help them select a plan to enroll in. One way to improve the consumer experience in marketplace websites is to show consumers more information up front—information that allows them to compare and contrast plan details and financial assistance benefits—before they invest time creating personal accounts and completing an application.
Discusses the consumer protections that marketplaces should consider implementing if marketplaces allow web brokers to enroll consumers in marketplace plans and financial assistance.
Learn what your state needs to include in its health insurance marketplace for consumers with limited English proficiency.