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What You Need to Know: Narrow or Broad Networks?

This article is part of a series on what you should look for in your health plan.

GDA_20160629_Biddy-01-EditGDA Group Health Plan Open Enrollment is available to members through December 9. Call Christy Biddy, your Medical Insurance Benefits Manager, at (800) 432-4357 for information, or visit us online at www.gadental.org/health to see our complete plan information.

This is part of an ongoing series about what you need to know as you compare health plans this year.


Health Insurance In the News

On its website, CNBC (10/26, Mangan) reports that according to an analysis conducted by HealthPocket, individual deductibles for the lowest-priced Affordable Care Act “plans will average more than $6,000 in 2017, the first time that threshold has been cracked in the three years” since ACA marketplaces were established. Deductibles for families are expected to average $12,393. The analysis also revealed that “average premiums, or monthly payments, for bronze plans nationwide will increase 21 percent next year for people who earn too much to qualify for Obamacare subsidies.” 


What You Need to Know

Narrow and Broad Networks

Also due to the advent of the ACA, we are seeing many “narrow-network” health plans being offered, particularly on the exchanges. Narrow networks typically contain a smaller number of providers and in-network facilities than traditional provider networks with the aim of offering lower premiums. Approximately 70% of plans sold on the health care exchanges in 2014 featured a narrow network. Georgia had the highest percentage, 83 percent, of “narrow’’ insurance networks in the 2014 health exchanges. University of Pennsylvania researchers found that five of six Georgia “Silver” exchange plans offered in 2014 had medical provider networks with a limited choice of doctors.

You might think lower premiums are automatically a good thing whatever the case. But there is growing concern that narrow networks can force patients to switch doctors or drive long distances for care if a key hospital is left out of the plan. If you have a chronic condition, leaving a network to seek specialized care can lead to big out-of-pocket bills. Then there is the issue of “surprise billing.” Say you are admitted to the hospital for an emergency procedure. You confirm that the hospital is part of your plan. However, when you receive your bill, you discover that the orthopedic surgeon, neurosurgeon, anesthesiologist, or even the ER doctor is not a participating provider in your narrow network, and you are being charged an out-of-network fee. How can this be? Hospitals do accept insurance plans for the doctors they directly employ, but many doctors are not employed by their hospitals. Instead, they’re independent contractors who may choose which health plans they participate in.

Health plans with broad networks, meanwhile, give you greater control over your health care with access to tens of thousands of your desired specialists, doctors, and hospitals. 

Bonus Coverages

Many plans offered on the exchanges are bare bones, offering few if any bonus coverages. As another benefit of your association group plan, health plan participants under the age of 65 (not dependents) are automatically enrolled for $10,000 of term life coverage. Participants also have the option of adding vision coverage where they can use in-network benefits at 1-800 CONTACTS, choose a private practice eye doctor, or go in store to LensCrafters®, Sears OpticalSM, Target Optical®, JCPenney® Optical, and most Pearle Vision® locations.


Did You Know?

The current GDA health plan is considered a broad network plan, offering competitively priced plans that are significantly inclusive of doctors, specialists, and hospitals throughout the state.

Christy Biddy is your Medical Benefits Coordinator, and can be reached at christy@gadental.org or 404.636.7553 x113.


Open Enrollment 2016 Health Plans
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