Providers Paid Substantially Less By Marketplace Nongroup Insurers Than By Employer Small-Group Plans, 2021.
Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the Affordable Care Act (ACA), where narrow networks and low-cost insurers are more prevalent. We estimated...
| Published in: | Health Affairs Vol. 43; no. 12; pp. 1672 - 1680 |
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| Main Authors: | , , , |
| Format: | research tables/charts Journal Article |
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Health Affairs Publishing, LLC
Dec2024
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=190587897&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 190587897 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02782715 HAF jtl: Health Affairs issn: 02782715 maglogo: N pubinfo: dt: Dec2024 vid: 43 iid: 12 pid: 1453 pub: Health Affairs Publishing, LLC place: Washington, District of Columbia artinfo: ui: 190587897 190587897 190587897 10.1377/hlthaff.2024.00913 190587897 ppf: 1672 ppct: 8 formats: tig: atl: Providers Paid Substantially Less By Marketplace Nongroup Insurers Than By Employer Small-Group Plans, 2021. aug: au: Hanson, Caroline McCarthy, Ian Molloy, Eamon Stockley, Karen affil: Congressional Budget Office, Washington, D.C. sug: subj: Insurance Carriers Economics Insurance, Health Economics Medicare Economics Health Benefit Plans, Employee Economics Health Insurance Exchanges Economics Human Patient Protection and Affordable Care Act Fee for Service Plans Insurance Coverage Adolescence Adult Employees Descriptive Statistics Adolescent: 13-18 years Adult: 19-44 years ab: Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the Affordable Care Act (ACA), where narrow networks and low-cost insurers are more prevalent. We estimated prices for three market segments (Marketplace nongroup, off-Marketplace nongroup, and employer small group) and three types of services (professional, outpatient hospital, and inpatient hospital) relative to a Medicare benchmark. We used 2021 claims data covering virtually all enrollment in ACA risk-adjusted plans. In aggregate, in 2021, Marketplace prices were 152 percent of Medicare prices, whereas the prices paid in small-group employer plans were 179 percent of Medicare prices. Comparing across market segments, relative to employer small-group plans, Marketplace professional prices were 6.9 percent lower, inpatient prices were 13.3 percent lower, and outpatient prices were 26.3 percent lower. Off-Marketplace prices fell between Marketplace and employer small-group prices. The finding that nongroup prices were significantly lower than prices paid by employer small-group plans--more so than indicated by prior research--is important for understanding federal subsidies and affordability for nongroup coverage and evaluating policies such as a nongroup public option with prices capped at a percentage of Medicare prices. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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