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Is a Narrow Network Right for You?

Healthcare choices can be complex. One of the biggest decisions we make each year is the health insurance plan we choose. With January only a couple of months away, many employees are revving up their company’s open enrollment period. During this time, employees are presented with different health insurance plan options and are expected to select the plan that best fits their family’s needs.

More and more, insurance plans are offering narrower provider networks. A network is a group of hospitals, doctors, pharmacies, etc. with whom the insurance company has contracted for health services at a discounted rate. Those discounts are passed on to the plan members. So, by narrowing the network, insurance companies can ask for larger discounts for their members. With fewer providers in the network, the network providers are willing to discount their services for additional patients. While you may have less choice in terms of number of providers, the prices should be better.

Better pricing with fewer choices may be a good alternative for individuals looking for a lower cost alternative to broad coverage (larger network) plans. In some cases, health plans offering narrow networks are about 25% cheaper. So what about you? Is selecting a plan with a narrow network a viable option?

A Few Questions to Consider

1. Are you receiving care for an on-going, chronic condition?
If you have a chronic condition or are receiving ongoing medical care that probably means you have a primary care physician or specialists who manage your care. Before switching to a narrow network, check to see if your providers participate in that network. If they do, then this is a great option to save money. If they don’t, you will need to decide to stay with your current providers and pay more or switch providers and network.

2. Does your child use a pediatrician?
Your child’s pediatrician is part of a specific network. Switching to a narrow network might mean that you’ll have to switch pediatricians too. If you have a pediatrician you’d like to keep, make sure they are in the new network you’re considering. It may not be possible to keep the same doctor by switching to a narrow network.

3. Do you have a preference in which hospital you and your family visit?
Many narrow networks limit the hospitals that are covered. In some cases, only a single hospital will be in-network. Look into the details of the plan and consider the limitations of a single hospital before selecting a narrow network health plan. This is also important if you are seeing a specialist that only practices at a single facility.

4. Are you pregnant or trying to start a family?
If you are working with your OB/GYN to start a family, find out which hospitals they use to deliver. Then check to make sure that hospital is in-network. Again, a narrow network can be a great choice BUT out-of-network if almost always a bad choice.

5. Are you young and relatively healthy?
For some people, the amount of medical care required in nominal. In fact, some individuals don’t actually have a provider they visit on a regular basis, but rather switch doctors as needed. In this case, a narrow network might not have much of an impact and could save valuable dollars.

Narrow Networks

Have Questions About Narrow Networks?

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