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Prioritizing Cost vs. Access to Care in Choosing a Health Plan

When choosing a health plan for your group, it’s common to struggle with balancing cost with access to care. Read this blog post for further guidance on how to decide between a narrow and broad network plan for your group.

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Let’s start by defining narrow and broad network plans. Generally speaking, these terms refer to the number of in-network providers included in a health plan.

Most narrow network health plans are designed around one key trade-off: More limited options in exchange for lower premiums. Insurers form agreements with healthcare providers, who accept lower rates for their services in exchange for, theoretically, a higher volume of patients. Insurers can then share these savings with plan members in the form of lower premiums.

Providers within narrow networks frequently work together, and patients stand to benefit from these close working relationships. Another benefit is that narrow network plans typically do not require referrals from primary care physicians to see in-network specialists.

But exactly how narrow are narrow network plans? There isn’t a defined standard — it’s a relative term that insurance providers determine. A provider’s broad network plan might include 70% of area providers, whereas a narrow network might include anywhere from 10% to 25% of those providers.

For relatively healthy individuals looking to save on premiums (folks who might not anticipate the need for highly specialized care), narrow network plans can be a great fit. The key trade-off is that most narrow network plans do not include any support for out-of-network care. When a patient needs to see a specialist outside of that network, they sometimes wind up paying the total cost for that care — which can be staggering.

How Does Prioritizing Cost vs. Access to Care Affect Plan Members?

This brings us back to the choice facing many employers: Is it the right decision for your group to prioritize cost and switch to a narrow network plan, even if it means limiting access to care?

This question can be difficult to answer on behalf of a group. While you probably have some employees who want to reduce costs (typically younger and healthier individuals), you undoubtedly also have team members who rely on access to a broad network of specialists to receive the care they need. For this second group, switching to a narrow network plan might make getting the care they need financially impossible.

There are several other factors to consider in this decision, such as whether the majority of your plan members live in an urban or rural area. The number of provider options (especially specialists) in a narrow network plan in a densely populated urban area will be far greater than a similar plan in a rural area. In more rural areas, a narrow network plan might require driving hours to see an in-network specialist; while plan members might save on premiums, they incur other costs, such as childcare, mileage, time off of work, etc.

Some employers opt to offer both narrow and broad network plan options, a choice that is more expensive while allowing them to avoid forcing the hand of their employees. Others will pair narrow network plans with supplemental benefits to make out-of-pocket costs more manageable for employees.

Regardless of whether you choose a broad or narrow network plan, you might have employees who struggle to afford the costs associated with the plan. For this reason, hundreds of employers have chosen to offer Paytient as a low-cost, high-value benefit to employees.

Improve Financial Health With Paytient

It's easy to oversimplify this debate of narrow network vs. broad network, but choosing a health insurance plan for your group inevitably involves trade-offs. A plan that saves one member money by reducing premiums could increase costs for another in the form of out-of-network expenses. Offering Paytient as a benefit can help reduce risk across the board by giving plan members access to funds they can use to cover any out-of-pocket costs.

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