Trouble with Obamacare plans in Pennsylvania

[Salty]

My spouse and I currently are retired ( 63 and 54) and are considering a relo to Bucks County PA area ( Doylestown, New Hope or Newtown), We currently live in Massachusetts where we have purchased our health insurance on the Obamacare website for Ma ( Massachusetts Health Connector) for the past two years. While the " Silver " level coverage is expensive, has high deductibles etc, it is virtually accepted everywhere including the Boston top doctors and hospitals. While it is technically an HMO , my primary care Dr is excellent and getting referrals anywhere I need to is not an issue. Overall it has been a very positive experience except

In considering a Bucks County PA relo, I have noticed some people are having trouble getting doctors to accept their health insurance purchased on the Healthcare.gov or Obamacare website, even a PPO! My spouse had an issue a few years ago that required us to seek emergency care with a retina specialist while visiting in California a year ago. I noticed a sign in the Doctor office that stated " We no longer accept plans purchased through Covered California" ( Ca Obamacare website).This got me thinking that I really need to do some thorough research on Obamacare in the two states we are considering a relo to ( PA and California)
Has anyone in Pennsylvania had issues with their Doctors NOT accepting Obamacare plans??
I want to thoroughly research this issue before I put our " easy" access to insurance in Massachusetts at risk!

All insight is appreciated., especially those in the Pa area!

PS, I posted a similar message regarding California's Obamacare, as that is on of two states we are considering as well

 

[MichaelB]

Didn't we just have this exact same discussion for California? http://www.early-retirement.org/for...covered-california-plans-even-ppos-83114.html

 

[travelover]

You don't need to purchase health insurance off the exchange, just buy it directly from the insurer.

 

[MichaelB]

My spouse and I currently are retired ( 63 and 54) and are considering a relo to Bucks County PA area ( Doylestown, New Hope or Newtown), We currently live in Massachusetts where we have purchased our health insurance on the Obamacare website for Ma ( Massachusetts Health Connector) for the past two years. While the " Silver " level coverage is expensive, has high deductibles etc, it is virtually accepted everywhere including the Boston top doctors and hospitals. While it is technically an HMO , my primary care Dr is excellent and getting referrals anywhere I need to is not an issue. Overall it has been a very positive experience except

In considering a Bucks County PA relo, I have noticed some people are having trouble getting doctors to accept their health insurance purchased on the Healthcare.gov or Obamacare website, even a PPO! My spouse had an issue a few years ago that required us to seek emergency care with a retina specialist while visiting in California a year ago. I noticed a sign in the Doctor office that stated " We no longer accept plans purchased through Covered California" ( Ca Obamacare website).This got me thinking that I really need to do some thorough research on Obamacare in the two states we are considering a relo to ( PA and California)
Has anyone in Pennsylvania had issues with their Doctors NOT accepting Obamacare plans??
I want to thoroughly research this issue before I put our " easy" access to insurance in Massachusetts at risk!

All insight is appreciated., especially those in the Pa area!

PS, I posted a similar message regarding California's Obamacare, as that is on of two states we are considering as well

What specifically leads you to believe physicians in Penn. my not be accepting "Obamacare policies"? Your post references a situation in California.

 

[Salty]

Yes!
We are considering two states, PA and CA. The feedback was so helpful on CA we were hoping to find similar feedback on PA.
PA as you likely know, is on the " heathcare.gov" federal exchange, vs a state exchange. Healthcare is such a huge cost, we are trying to get some " first hand" experiences from both states
thanks!

 

[MichaelB]

Yes!
We are considering two states, PA and CA. The feedback was so helpful on CA we were hoping to find similar feedback on PA.
PA as you likely know, is on the " heathcare.gov" federal exchange, vs a state exchange. Healthcare is such a huge cost, we are trying to get some " first hand" experiences from both states
thanks!

Have you looked at any specific insurance policies and provider networks for the county you are considering as a retirement location?

 

[ExFlyBoy5]

What specifically leads you to believe physicians in Penn. my not be accepting "Obamacare policies"? Your post references a situation in California.

I think the OP is asking if anyone is facing a similar issue in PA as in CA....with CA being an example.

Sent via mobile device. Please excuse any grammatical errors.

 

[Salty]

Yes, however without " knowing" any doctors or physician groups it is hard to know who are the more desirable ones. We are researching physicians now, but it is somewhat a crap shoot.

 

[Salty]

yes, that is correct Exflyboy5. Health insurance access to good medical doctors and hospitals is our number 1 concern in a relo.

 

[MichaelB]

I think the OP is asking if anyone is facing a similar issue in PA as in CA....with CA being an example.

Sent via mobile device. Please excuse any grammatical errors.

Actually, there was a lengthy discussion initiated by the OP about California physicians acceptance of individual health insurance policies. The OP in this thread was worded identically, even down to the California reference. In a discussion of this nature, details and specifics are very helpful to other members.

yes, that is correct Exflyboy5. Health insurance access to good medical doctors and hospitals is our number 1 concern in a relo.

All the insurers have tools on their websites that show their provider networks. Have you looked at any of these?

Edit to add - I would guess that coverage options will be much different for the Pittsburgh or Philadelphia than for south or central Pennsylvania. Perhaps some more specific location info might help.

 

[Salty]

Thanks MichaelB
We are specifically looking in Bucks County PA, possible Montgomery County PA, both suburbs of Phila.

 

[rodi]

I lived in Montgomery county for close to a decade... but it was Pre-ACA. I had coworkers who lived in Bucks and also across the river in NJ.

The one take away of this experience Pre-ACA was that insurance was triple the cost in NJ than in Bucks or Montco. I worked for a megacorp that negotiated very competitive rates - but the folks who lived in Jersey paid a HUGE amount more... based solely on their zipcode/state.

In other words... New Hope good, Lambertville.... expensive.

 

[user5027]

I anxiously await informative replies. I am 58, retired, live in the Bucks County area described and bought unsubsidized Aetna bronze plans in 2015 and 2016 off the exchange. Wife still works and I am eligible for health insurance at her work but it would cost more. Fortunately for me I've had no doctor visits and no claims. When I bought the plans, the Penn Medicine office I have gone to for my last two checkups in 2008 and 2014 as well as both the gastro and the urologist I have seen before are all listed in network. I just checked MyAetna and they all are still listed.

Aetna announced they are pulling out of the ACA in PA.

 

[Salty]

Great imput - thanks Rodi.
Yes, if we go the PA route, it will be PA for sure, not NJ. Besides the delta in heathcare costs, property taxes and the savings on state tax relating to 401k distributions make PA the more desirable choice.

Thanks again for the heads up.

 

[Salty]

User5027
Any idea who you will go with in 2017 with Aetna pulling out?

 

[user5027]

User5027
Any idea who you will go with in 2017 with Aetna pulling out?

No idea. I suspect Aetna will be available off exchange. The pricing was identical from what I recall. I'll wait for the open enrollment and compare all options on/off exchange and through my wife at work.

Regarding PA vs NJ you are 100% correct. You do want to cross the river to buy your gas at least for now. The NJ Transportation Trust Fund is broke (revenues are only paying the bonds) and they propose raising the gas tax 23 cents per gallon. It was suppose to go into effect 7/1/16 but was not passed at the last minute. I went over to gas up on 6/30/16 and there was a line at the pumps. I thought I hit a 1970's time warp.

 

[Dash man]

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. We plan to buy from Blue Cross with a plan that is also accepted in Florida. We'll get through 2017 on Cobra then will make our change. I also have the option for an expensive but good retiree plan through the company I retired from.


Enjoying life!

 

[MichaelB]

Insurance policies differentiate themselves by their provider networks. To have an idea of the network size and breadth one has to look at specific policies. There really is no other way to compare.

I looked at plan offerings at healthsherpa and healthcare.gov for Bucks County.

Independence Health, the BCBS affiliate for Pennsylvania, has three offerings. An HMO, a regional PPO, and a BlueCard PPO. This is similar to their approach in other states. The HMO is called "Keystone HMO" and has the smallest provider network, and care is managed. The smaller PPO network is called "Personal Choice" and is also regional. The BlueCard Network is the "Multi-State Policy" and is the same large national network found in many group employer plans. Strangely, this policy is only available on the exchange, while the others are available both on and directly.

Aetna and UHC currently offer policies, but given their recent announcements, we will not know until October if they will continue to offer policies on 2017. Insurer policy offerings are updated yearly, so one never knows what next year will look like.

 

[Corporateburnout]

We live in MA and have policies through the health connector and like you we have no problems with any of our doctors and hospitals accepting our plans.

One thing to keep in mind, if the ACA is ever repealed MA will resort back to Romney care thus guaranteeing healthcare coverage especially with one of you still 11 years from Medicare.

 

[ducky911]

I have silver plan in CA. With a ok deductible. I can go to almost any doctor. So that all seems great...but..but...the low deducible is for only preferred providers. You can still go to non preferred providers but there is a separate deducible for that (15k).

And guess what you have to drive a hour to find anyone on the preferred list. Most doctors are jumping off the preferred list.

One of my existing doctors happened to be on the list and my 10 year colonoscopy was do so I had him do it only to find out that he has a seperate center that is not on the list. great

 

[bingybear]

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.

 

[travelover]

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.

 

[bingybear]

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

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).

 

[travelover]

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.

 

[gmshedd]

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.