Health Insurance Health Reform

The demise of PPOs in Health Insurance Exchange

A Robert Wood Johnson commentary by Katherine Hempstead provides insight into the evaluation of PPO offerings in health insurance exchange.

Since last year there has been a significant reduction in the number of PPOs offered in the Affordable Care Act (ACA) marketplaces. A prior analysis showed that of the 131 carriers offering silver PPO products in 2015, only about one-third remained unchanged in 2016, while the rest were either reduced in scope or eliminated…Since changes in the generosity of out-of-network coverage don’t affect a plan’s actuarial value (AV), carriers can adjust these features without affecting the AV status. Plans new to the market in 2016 provide less coverage for out-of-network providers as compared to those that are continued from last year.

Hempstead also notes that the PPO offerings in the Exchanges have relatively heterogeneous characteristics.

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