ACA plan enrollees have limited access to local doctors
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Affordable Care Act plan enrollees had in-network access to, on average, 40% of doctors near their homes in 2021, according to a new KFF analysis.
Why it matters: Plans control costs by contracting only with certain providers. But these more limited networks can hamper enrollees' ability to actually access the care their plan covers.
The big picture: As higher and higher percentages of Americans have gained health coverage, it's become clear that coverage alone doesn't guarantee access to care.
- That can be because of deductibles and out-of-pocket costs but also issues with making timely appointments or simply finding nearby doctors who are accepting new patients.
- Previous KFF research has found that people with ACA marketplace coverage are more likely than those with workplace coverage to report that a particular doctor or hospital they need isn't covered by their insurance.
By the numbers: The new KFF analysis found that nearly a quarter of ACA enrollees were in a plan with a network including only a quarter or fewer of doctors in their area.
- On average, 27% of actively practicing doctors weren't included in any ACA plan's network.
Among the types of plans used as the benchmark for federal premium subsidies, plans with higher shares of participating doctors had more expensive premiums.
- Plans in some large metro counties had some of the narrowest networks.
The bottom line: There's a tradeoff between premium cost and how many options enrollees have when choosing a doctor, and that tradeoff could be making care harder to access for ACA enrollees — who are generally a lower-income population.
