Doctor, Doctor Where Are you?

Here it is March and so much of the new insurance exchange requirements are still unknown. In six months the new Health Insurance Exchange mandated by the Affordable Care Act (ACA) will become operational. On October 1, 2013, every state and the District of Columbia will have either a state- or federally-operated Marketplace (or Exchange) to provide accessible health insurance to all legal Americans.

Insurance carriers are still weighing their options to see if and how they will participate within the Marketplace framework. Both the federally- and state-operated Marketplaces are still in negotiations with their state insurance carriers as to 1. how they will provide the required standard benefits (Qualified Health Plans – QHP) and 2. what the market price for each plan will be. The contracts and details for the required QHPs won’t be finalized until later this summer. Because there are millions of un-insured, under-insured, and even insured Americans waiting to benefit from the ACA requirements, more than likely, the big insurance carriers will be a part of the new exchange framework. Remember, health insurance carriers (i.e. Aetna, Anthem BCBS, Blue Cross/Blue Shield, United Healthcare, etc.*) have contracts with healthcare networks to take care of their insurance plans’ members…meaning you. Whichever insurance plan you choose determines which network of healthcare providers you can use (i.e. Doctors, hospitals, pharmacies, health clinics, etc.).

You are thinking, “Great! An easier way for me to find and possibly purchase or even upgrade my health insurance! Oh but wait! Do I get to keep my Doctor?” To be honest, no one really knows yet. Remember what was written above…the state insurance carriers have not been formally identified yet. Everything is still very much a moving target. The Marketplace, once up and running, will allow you to compare health insurance plans side by side – deductible amounts, monthly premiums, networks, etc. And, this is where you need to do your due-diligence. Before choosing a health insurance plan, your job is to read, review, and compare, compare, compare. When you get ready to choose or renew an insurance plan (via the Exchange or on the open market) review the list of providers/networks that are included in that plan. If staying with your current doctor, pharmacist, or hospital is important to you, then carefully check to see if they are included in that plan. Yes? No? Yeah, you found your Doctor! BUT no, he is in a different plan!

Look very closely at what the different plans have to offer…it’s all the in the details. What are the differences in between the plans? What is the trade-off with keeping your Doctor but paying a different premium, deductible, or out-of-pocket amount? Is it better to give up your favorite Doctor and go with a plan and network that better fits your needs? Or do you like your Doctor and hospital enough that a difference is worth it for your comfort level and peace of mind? Don’t forget, even with the Insurance Marketplace operational, you can still purchase health insurance on the open market. You are not required to purchase insurance through the Exchange. And maybe THERE is where you find your Doctor with the plan that fits your needs. Only you can decide what is best for you and your family. Remember weigh the pros and cons of each plan, both inside and outside the Marketplace, before signing on the bottom line.

*Note, this is just a sampling of insurance carriers. The list of carriers is much too big to be included in its totality in this blog.

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