March 2015

How Narrow a Network Is Too Narrow?

Author Affiliations
  • 1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
  • 2Institute for Social Research, University of Michigan, Ann Arbor

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2015;175(3):337-338. doi:10.1001/jamainternmed.2014.7763

The second open-enrollment period for coverage through the Health Insurance Marketplace extends from November 15, 2014, to February 15, 2015; millions of people in the United States are once again choosing from a menu of plans. Although federal law dictates some aspects of the plans, shopping for coverage—even on health insurance exchanges that are well organized—can feel like little more than educated guesswork.

The financial considerations, such as premiums, deductibles, and copayments, are relatively transparent. Plans must provide a minimum level of financial protection and are categorized as bronze, silver, gold, or platinum, depending on the share of medical expenses that they would cover for typical enrollees. The law also requires that plans must cover certain services, including physician visits, hospitalizations, and prescription drugs, and cover preventive services such as influenza shots and high blood pressure screening without copays. But in other dimensions, the plans may vary considerably.

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