Narrow Provider Networks For Exchange Health Plans?

An article in today's Wall Street Journal reinforces something we brokers have known for quite some time--health exchange plans will have limited provider networks for access to healthcare.

These networks, known as limited or narrow networks (a newer term is ACO - accountable care org) will have a much smaller number of participating providers and will be working with lower negotiated rate schedules than traditional networks such as Blue Cross' Prudent Buyer Network.

For those who purchase health coverage inside of the exchange, the availability of healthcare providers will be markedly less than plans sold on the open market.  This may mean that Blue Cross or Blue Shield PPO health plans may not offer BlueCard national PPO access on plans sold through the exchange leaving that benefit to normal network plans sold outside of the exchange.

Once the California health plans are developed and released for the exchange and non-exchange markets, we will have a clearer idea about the networks available in both markets.



  1. the main question should be how will this impact the industry?


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