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Old 08-21-2016, 05:33 PM   #21
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You don't need to purchase health insurance off the exchange, just buy it directly from the insurer.
buying directly from the insurer is off the exchange. When you buy directly from the insurer, you are not able to get the subsidy.
Note that one insurer I looked at noted that with their plans the network off exchange has some differences that on exchange as some doctors don't want to support both.
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Old 08-21-2016, 05:35 PM   #22
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Originally Posted by bingybear View Post
buying directly from the insurer is off the exchange. When you buy directly from the insurer, you are not able to get the subsidy.
Note that one insurer I looked at noted that with their plans the network off exchange has some differences that on exchange as some doctors don't want to support both.
I know that. The OP was worried that he couldn't find a doc to take an ACA plan. The easy solution is to not buy an ACA plan on the exchange.
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Old 08-21-2016, 05:46 PM   #23
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I know that. The OP was worried that he couldn't find a doc to take an ACA plan. The easy solution is to not buy an ACA plan on the exchange.
sorry. when I read
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You don't need to purchase health insurance off the exchange, just buy it directly from the insurer.
I did not take "off the exchange" to mean from the exchange. I took it to mean not from the exchange.

But both plans from the insurer and from the exchange are both ACA compliant (ACA plans).
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Old 08-21-2016, 06:04 PM   #24
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sorry. when I read
I did not take "off the exchange" to mean from the exchange. I took it to mean not from the exchange.

But both plans from the insurer and from the exchange are both ACA compliant (ACA plans).
OK to clarify. If you are worried about the network, just go to an insurance agent to buy health insurance.
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Old 08-22-2016, 05:52 AM   #25
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I have purchased insurance for myself, and for my DW through the exchange in PA for the past two years, as well as purchasing Medicare Advantage plans for my parents through the Medicare website for many years. The ONLY thing I can say for sure is that the plans change every year, and that you need to dig deep to determine which doctors and hospitals are covered every year. We live near the border with NY, and our plans covered doctors in NY one year, and dropped them the next. Part D plans change their formularies each year (i.e., deductibles for each drug). How was my 81-year old, internet-disabled father supposed to decide between Part D plans that could differ by thousands of dollars in OOP expenses? I am truly amazed that anyone can suggest that this annual reshuffling of the deck in the name of "competition" is in the best interests of the citizens. It's obvious that the changes (and the resulting confusion) are in the best interests of the insurance companies, not the insured.
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Old 08-22-2016, 02:37 PM   #26
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Thank you everyone! I had not thought about buying the insurance direct from the insurance co, OR a broker. We will not qualify for a subsidy, so this may be the best option, and hopefully will have wider acceptance-
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Old 08-22-2016, 07:27 PM   #27
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Another possible option is to buy from an HMO you can live with. We have been covered through Kaiser on the exchange since the start of 2014 and while the billing has been wildly screwed up this year (courtesy of the state exchange), the care has been flawless.
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Old 08-24-2016, 08:00 AM   #28
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I'd recommend buying directly from the insurer in PA. Out kids have had a hard time finding quality doctors that accept healthcare from the exchange in Philly.
I really don't get these discussions, given that off-exchange plans are generally the exact same plans you get on the exchange (same networks).

I understand that if you're in expanded Medicaid you're going to have issues with exchange plans, but someone please explain why an ACA plan would have provider issues with the same network you get with an off-exchange plan. Are insurers running different (i.e. limited) networks with ACA plans, and if so how is that legal?
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Old 08-24-2016, 08:46 AM   #29
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I understand that if you're in expanded Medicaid you're going to have issues with exchange plans, but someone please explain why an ACA plan would have provider issues with the same network you get with an off-exchange plan. Are insurers running different (i.e. limited) networks with ACA plans, and if so how is that legal?
There are other discussions on this but I can tell you that when I had Coventry (bought through a broker, off-exchange), my gyno's office told me they didn't take the Coventry from the Exchange but they accepted mine.

So yes, they CAN offer a plan on the Exchange with a more limited network (and, presumably, lower rates negotiated with the docs, which decreases the number of docs willing to be in the network). I have no problem with that, but I do believe that insurers shouldn't be allowed to change their networks OR their prescription formularies after Open Enrollment. That's just plain bait-and-switch. It's also an under-the-table rate increase since you're getting less coverage than what was offered when you signed up.
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Old 08-24-2016, 09:47 AM   #30
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So yes, they CAN offer a plan on the Exchange with a more limited network (and, presumably, lower rates negotiated with the docs, which decreases the number of docs willing to be in the network). I have no problem with that, but I do believe that insurers shouldn't be allowed to change their networks OR their prescription formularies after Open Enrollment. That's just plain bait-and-switch. It's also an under-the-table rate increase since you're getting less coverage than what was offered when you signed up.
My understanding is that these groups and network participation are negotiated annually. So in most situations, an insurer or provider can't suddenly decide, midyear, to stop a particular provider's network participation (or change the formulary). They can, however, change the network and/or formulary for the *next* calendar year. So it becomes important to confirm, at open enrollment time, that your in-network docs and facilities will still be in network.
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