If you’re looking for summer plans, look no further! From now until September, it’s time to weigh in on 2016 Marketplace plans. Our final destination? To ensure that consumers have access to a sufficient number of providers to deliver quality and affordable health care services included in their benefits packages – otherwise known as network adequacy.
Why is network adequacy even an issue? The Affordable Care Act offers broad guard-rails for network adequacy for plans participating in the Marketplaces. However significant work remains at the state level in terms of implementation of more specific standards, monitoring, and enforcement. Critical gaps still remain for consumers and their health plan networks.
The road to stronger network adequacy will involve the steady, active collaboration of state officials that oversee Marketplace plan certification and network adequacy enforcement (usually the Department of Insurance or Department of Health), providers, insurers, policymakers, advocates and consumers. Now is the time to make sure 2016 Marketplace plans do a better job supporting a positive health coverage experience for consumers.
The journey begins with key stakeholders forging agreement around five consumer-focused network adequacy principles—accessibility, availability, affordability, quality and transparency. These principles serve as a foundation to then navigate through more specific regulatory and policy priorities found in this Network Adequacy Checklist. This checklist serves as a guide for stakeholders to:
- Identify and understand the issues to watch and what types of consumer stories to collect
- Help stakeholders and coalitions develop priorities
- Develop solutions based on issues identified
- Assess proposed bills for alignment with consumer protections as well as gaps
Who needs the beach or a vacation when the Marketplace plan review process is waiting for you?