Some Insurance Marketplace Plans Missing Key Physician Specialists

A study published in the Journal of the American Medical Association (JAMA) discovered several health plans on the Affordable Care Act (ACA) marketplace are missing key specialists in their physician networks. Out of the 34 states JAMA researched, nine had at least one “specialist-deficient” plan, with the most common specialties omitted being rheumatology, endocrinology, and psychiatry. So what does this mean for patients?

“If somebody needed to access a psychiatrist or a rheumatologist, or they had a thyroid disorder and needed an endocrinologist, they would not be able to find an in-network specialist to care for them,” Stephen Dorner, a medical student and author of the study told NPR.

Patients who do end up visiting a specialist not covered by their marketplace plan may end up paying high out-of-network costs, explains NPR. Read more.

Another recently completed study found wide variation around the country on the “narrowness” of the ACA marketplace plans. At 45 percent, Texas led the nation in the share of marketplace plans rated “x-small.” Eight of the 11 (73 percent) ACA marketplace plan networks in Texas were rated either “small” or “x-small.”  That placed Texas tied for fifth worst in the country, after Georgia (83 percent), Florida (79 percent), Oklahoma (78 percent), and California (75 percent.)