Insurers in Government-Run Exchanges to Expand Provider Networks by 30% in 2015

Tony Berberabe, MPH @OncBiz_Wiz
Published: Wednesday, Feb 05, 2014

A news story from Bloomberg Business News suggests that insurers who are participating in government-run health insurance exchanges will be required to increase “essential community providers” in their local geographic area by 30% by 2015. That’s an increase from 20% this year, according to a draft letter issued by the Department of Health and Human Services.

The expansion focuses on providers who predominantly serve low-income and medically underserved individuals. The letter provides insurers who are interested in offering Qualified Health Plans (QHPs), including stand-alone dental plans (SADPs), in a federally-facilitated marketplace (FFM) or federally-facilitated small business health options program (FF-SHOP) with operational and technical guidance to help the insurer successfully participate in the marketplaces.

The Bloomberg story reports that insurers say smaller networks of hospitals and doctors help contain costs and improve care. But providers serving low-income people have complained that exchange plans won’t allow them to join the networks, said Sara Rosenbaum, a professor of health policy at George Washington University.

“Everybody is obviously very concerned that what’s going to happen is their patients will be swept away — they will not be identified as preferred providers in networks,” Rosenbaum said in a Bloomberg interview. “Clearly something has set off alarm bells.”

About 3 million people signed up as of January 24 for private health insurance plans offered by the new marketplaces, HHS has said. WellPoint Inc., the second-biggest US insurer, said it had added 500,000 members through the exchanges set up by the law commonly known as Obamacare.

Although this is only a draft letter, the Centers for Medicare & Medicaid Services (CMS) welcomes any comments on the proposed guidance. Comments about the letter may be e-mailed to by February 25. 2014.

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