Narrow Networks, Access to Hospitals and Premiums: An Analysis of Marketplace Products in Six Cities

One objective of the health insurance Marketplaces created through the Affordable Care Act (ACA) is to encourage competition among insurers with the goal of lower premiums for consumers and lower subsidy costs for the federal government. One strategy insurers have used to offer lower premiums and capture market share has been the creation of “narrow networks” of providers and facilities. The ACA includes network adequacy requirements, but there remains considerable variation in the breadth of acceptable hospital networks and the options available in each. This brief investigates which hospitals are included in Marketplace plans in major cities in six states, and examines how hospital networks vary across plans within a single insurer and across all insurers.