Network Direction

Health plans operating on the federally run insurance exchanges in 2015 must include broader provider networks, according to a March 14 CMS letter to insurers. Carriers on the exchange in 2015 must include 30% of an area’s “essential community providers,” up from 20% in 2014, CMS said. Essential community providers include hospitals that generally serve low-income patients. In addition, CMS said it would take a more active role in reviewing health plan networks. Among other things, CMS said it will evaluate whether plans on the exchange include enough access to hospitals, primary care doctors, mental health providers and oncologists. In a March 14 interview on WebMD, President Obama said that pressure to keep down costs could mean consumers may not have access to their choice of doctor. “You may find out that network is more expensive than another network, then you have to make choices in terms of what’s right for your family,” Obama told WebMD, according to a March 14 article in The Washington Post. “Do you want to save on costs, or do you want to save on convenience?”