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September 11, 2017

Narrow-network ACA plans may especially limit mental health options, study finds

Daily Briefing

    Narrow-network health plans sold on the Affordable Care Act's (ACA) exchanges in 2016 offered enrollees a limited selection of mental health care providers, according to a study published Tuesday in Health Affairs.

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    Study details

    For the study, researchers used 2016 data on 531 unique provider networks in exchange plans to evaluate the network sizes and compare the share of primary care providers—designated as the control group—with the percentage of mental health care providers available in each network. The researchers defined narrow-network health plans as those that included fewer than 25 percent of providers in a particular health insurance market.  

    The researchers noted the lack of data on behavioral health carve-out plans—which rely on specialized management firms to offer mental health services separately from other health care benefits—as one of the study's limitations. The absence of such data could have led researchers to underestimate the number of available mental health care providers for enrollees in narrow-network plans.


    The researchers found that, overall, narrow-network health plans included 24.3 percent of all primary care providers and 11.3 percent of all mental health care providers who practiced in a given state's exchange plans.

    According to the study, provider participation in mental health networks was low when compared participation in primary care networks, with only 42.7 percent of psychiatrists and 19.3 percent of non-physician mental health care providers participating in a network.


    Study lead author Jane Zhu of the University of Pennsylvania's Perelman School of Medicine said, "The ACA doesn't specify what constitutes a plan that's too narrow, and a concern is that a plan that's too narrow might exclude behavioral health specialists or push people out-of-network, which is associated with higher out-of-pocket costs and may reduce access to care."

    Benjamin Le Cook—a researcher at Harvard Medical School, who was not involved in the study—said before the ACA became law, fewer than half of U.S. residents with a mental health condition received any type of care.

    Cook said that "with the advent of the ACA [exchanges], many patients and families that need mental health care have new opportunities for finding affordable insurance that they did not have pre-ACA." However, he said, "[T]his study shows that these families and patients need to shop (for) insurance plans carefully on both price and availability of mental health providers," adding that it might be "worth it to them to pay a higher premium to get a mental health provider that can provide the best treatment for them or their family member" (Rapaport, Reuters, 9/7; Baker, "Vitals," Axios, 9/6; Zhu, Health Affairs, 9/5).

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