Silver Dominates Exchange Plans

Ninety-three percent of exchange networks are offered on the Silver tier. It’s the only tier in which income-eligible consumers can get federal premium and cost- sharing subsidies, according to a study by McKinsey & Co. More than 60% of consumers who enrolled in an exchange product chose one in the Silver tier. Broad networks have more than 70% of hospitals in the rating area participating; narrow networks have 31% to 70%, and ultra-narrow networks have 30% or less.

Consumers now have an expanded choice of network offerings at the point of health plan purchase on exchanges. Broad networks are available to close to 90% of the addressable population. In addition, narrowed networks are available to 92% of that population; they make up 48% of exchange networks across the U.S. and 60% of the networks in the largest city in each state.

Certain market conditions are associated with having more narrowed networks, such as higher excess bed capacity, more provider or payor fragmentation, and more significant potential for growth from the uninsured.

Seventy-five percent of ultra-narrow, silver-tier plans only include some of the hospitals within participating health systems. Forty-four percent exclude at least one hospital from every single participating health system. Ultra-narrow networks that exclude hospitals from every participating health system are priced an average of 13% lower than ultra-narrow networks containing entire health systems.

Forty-two percent of consumers who enrolled in an ACA plan and were aware of the network type purchased a plan with a narrowed network. However, 26% of those who enrolled in an ACA plan were unaware of the network type they had selected. For more information, visit

Last Updated 08/10/2022

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