Under intense pressure to curb costs that have led to losses on the Affordable Care Act exchanges, insurers are accelerating their move toward plans that offer limited choices of doctors and hospitals.
A new McKinsey & Co. analysis of regulatory filings for 18 states and the District of Columbia found that 75% of the offerings on their exchanges in 2017 will likely be health-maintenance organizations or a similar plan design known as an exclusive provider organization, or EPO. Both typically require consumers to use an often-narrow network of health-care providers—in some cases, just one large hospital system and its affiliated facilities and doctors.
Only a quarter of the exchange plans next year would still be broader designs such as preferred-provider organizations, or PPOs, which generally offer larger selections of doctors and hospitals and include out-of-network coverage, the McKinsey analysis found.
Insurers offering HMO-style exchange plans “tend to have higher margins and lower rate increases,” said Erica Coe, a McKinsey partner who leads the firm’s health-reform research effort.
For consumers like Alexei Solcanu, a software engineer who lives in Matthews, N.C., a shift to a plan with a different network could mean changing health-care providers at a critical time. Mr. Solcanu’s wife is pregnant, with a baby due in January. His current insurer, Aetna Inc., is exiting the state’s ACA marketplace next year and he doesn’t know whether the remaining choices will include his wife’s doctor and hospital. “I’m worried,” said Mr. Solcanu, 26. “That’s my biggest concern.” The details of 2017 exchange plans aren’t expected to be available to consumers until October.
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