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What Will Happen To Your Out Of Network Benefits?

December 13th, 2013

Credit: Ōmono via Flickr under Creative Commons

Credit: Ōmono via Flickr under Creative Commons

In 2010 when the Affordable Care Act (ACA) was signed into law, many didn’t expect that the consumer protections it offers could end up actually doing the opposite. At the center of the law is the online health insurance exchange at HealthCare.gov. Insurance companies participating in this exchange have to comply with a pretty large list of regulations and requirements.

For example, every plan an insurance company offers on the exchange has to include coverage for the ten categories of medical services known as essential health benefits. These benefits and regulations were put in place to protect consumers, but have also resulted in higher costs for insurance companies. The result is that insurers need to make cuts somewhere to make up for these losses.

The Price: Out Of Network Benefits

One of the ways insurance companies are making their money back is through eliminating out of network benefits for most of their plans both on and off of the exchange. It might not sound like such a big deal at first, but there is a lot of value in having out of network benefits. They allow you to get treatment from the best hospitals and specialists around the country. For example, say that you need to have an uncommon type of surgery done. It’d probably be better to go see someone who specializes in this kind of surgery, but there might not be someone like that locally or in your provider network. You are still welcome to see an out of network specialist if you have an exchange plan, but you’ll end up paying for everything out of pocket.

Furthermore, insurance companies are making it so that your network is only statewide. If you live in Iowa and have exchange plan X, the specialist you need to see in New York could be part of exchange plan X’s network there. Even though it is the same plan in different states that doctor will still be seen as out of your network. This issue is only made more difficult by shrinking network sizes.

Stay Cautious

The truth is that unless you have a large group grandfathered plan, you are not going to have out of network benefits. When you are looking at plans, it is important to remember this. There is no doubt that there are already a lot of things you have to worry about when you’re choosing between different health insurance plans. This cutting of out of network benefits only makes things more stressful, eventually turning into another thing that will cost you money down the road.

As the Affordable Care Act spends more time in the spotlight, we’re finding more parts of it that may need a second look. While this issue of out of network benefits is mostly the decision of insurers, the ACA certainly played a direct role in it. As more problems like this one become apparent to consumers, it won’t be surprising if we see the legislation itself being revisited in the future.

Will You Be Able To Keep Your Doctor?

December 6th, 2013

This week’s post comes to us from Tony Catalano. Tony  is a contributing writer to the ForHealthInsurance.com blog. He has a BA in Creative Writing and a BS in Contemporary Music Studies from SUNY New Paltz. Tony is a  New York native, and works as a freelance writer and musician.

Lower Costs, Smaller Network

One of the biggest worries with the Affordable Care Act (ACA) is not only whether people will be able to keep their plans, but also whether or not they can keep their doctor. Unfortunately, things are not looking so sunny on that front. It isn’t a guarantee that you will have to get a new doctor, but there is certainly a good chance. To learn a little bit more about the situation, read on.

Credit: dno1967b via Flickr under Creative Commons

Credit: dno1967b via Flickr under Creative Commons

As the name implies, the intention of the ACA is to make health insurance affordable for consumers. Faced with stricter regulations, one of the ways that insurance companies have kept the cost of their premiums down is by reducing the size of their networks for plans sold on the exchange. The positive part is that you may be able to get a tax credit on an exchange plan. However is the risk of losing your doctor worth it to you?

Additionally, finding out what doctors are in a given plan’s network is not as easy as it should be. Some states don’t list their plans’ networks on their exchange sites, or feature less than stellar ‘doctor finder’ features. If you are having trouble finding out a plan’s network, your best bet is to call the exchange’s help line or to talk to a representative from the insurance company in question.

Cutting Reimbursements

Another way that health insurance companies are keeping their costs down is by reducing the amount of reimbursements doctors get, in some cases bringing it below Medicaid levels. It seems only natural that a lot of doctors aren’t so happy with this. Add it all up and you have doctors who are being cut out of various plans’ networks as well as doctors who are opting out on their own accord.

The Net Result

If you have lost your doctor after enrolling in an exchange plan, you are clearly not in the best of situations. Your choices for a doctor are now much more limited than they were in the past. Numerous people are going to enroll in these exchange plans with smaller networks. Add in the looming doctor shortage, and it wouldn’t be unreasonable to expect long wait times in crowded lobbies. Not exactly the most attractive mental picture.

What Can I Do?

The truth is there is only so much you can do. To get a plan with the doctor you want, you are going to have to research a fair bit and choose a plan carefully. In the best possible outcome you could find an exchange plan where you keep your doctor and get a hefty tax subsidy, but there may be a minimal chance of that situation becoming a reality for you.

If it isn’t clear already, don’t rush into buying an exchange plan. Carefully think about and evaluate each plan, and if you need to contact someone to find a given plan’s network then do so. If evaluating all of these different factors is a bit too much to handle or you just need some help, contact a broker or a navigator to help you.