Do you know if your health insurance plan has a limited or broad network? It’s not something that insurance companies say explicitly, but it’s important for members to know.
what is a wide network health plan?
Most people imagine wide nets when they think of employer-sponsored insurance plans. These plans include a wide range of area primary care physicians, specialists, and hospitals.
Reading: What is broad network insurance
what is a narrow network health plan?
As the name suggests, narrow networks tend to have narrower coverage and include a smaller portion of area providers.
but exactly how narrow is narrow? while this can vary significantly between providers, there are some general guidelines to keep in mind. while a broad network plan might include about 70% of area providers, a narrow network might include only 10% to 25% of those providers.
many insurance providers have been adding narrow network plans as a way to control costs. partner with health care providers who accept lower fees in exchange for higher patient volume. these savings are then passed on to plan members (and their employers) in the form of lower premiums.
Although narrow-net plans have been a staple for self-insured people since the passage of the Affordable Care Act, these plans have not been as common for people who get insurance through their employers.
Due to the rising cost of premiums, narrow-network plans have become popular with group buyers as a more affordable alternative to traditional wide-network health insurance. Let’s take a moment to explore the factors companies consider when choosing between these plans.
choose between narrow and wide networks
The decision between narrow or wide network health insurance comes down to two factors: cost and access to care. while narrow networks tend to have more affordable premiums (16% cheaper, according to one study), they have a more limited number of care options available to plan members.
but it’s a bit more complicated than that. when members on narrow network plans need to seek care outside of their networks, it can be significantly more expensive than if they were on a wide network plan.
This is a big part of the reason narrownet plans are more affordable. Wide network health insurance generally provides some coverage, including for out-of-network providers, in the form of a copay or coinsurance. narrow network plans generally don’t, making narrow network health plans more profitable for insurers.
Keep in mind that your chances of needing an out-of-network provider are slightly higher when your in-network options are limited, especially if you live in a rural area with limited access to specialty care. this can make the decision of what to prioritize (cost or access to care) so difficult, especially on behalf of a group. The same plan that saves one member money by lowering monthly premiums may cause another member to incur exorbitant costs through out-of-network providers.
Some employers choose to offer their employees limited and wide network health insurance options. this is often more expensive for the employer than just offering a narrow network plan, but it gives employees more flexibility to choose a plan that makes the most sense for them.
It is impossible to select a “perfect” plan for everyone in a group. The best thing you can do is provide options that allow your plan members to customize their coverage and payment options.
how paytient removes barriers to care
offering paytient as a benefit is one way to offer such options. paytient is a health plan and employer-sponsored benefit that gives members access to interest-free funds they can use to pay for medical, dental, vision and even veterinary expenses. members use their payment cards to spread large health care costs into a series of smaller payments, at a pace that works best for them.
If you choose to exclusively offer a narrow network plan to your members, paytient can act as a buffer to help cover any out-of-pocket costs. this includes deductibles, copays, coinsurance, and any costs associated with seeing out-of-network providers.
If you decide to go with wide network health insurance, paytient still provides peace of mind for members who could pay for their care in full. instead of paying a lump sum at the time of service, they can use paytient to spread those expenses over time and minimize the impact on their monthly budget.
paytient’s mission is to remove unnecessary financial harm from the health care system. Whether you choose to offer a narrow or wide network plan, or both, Paytient can help make the plan work for more of your members. Instead of using a high-interest credit card, payday loan, or other more toxic means of paying for care, plan members can use paytient to get the care they need now and focus on getting better.