Trouble with Obamacare plans in Pennsylvania

[Salty]

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-

 

[brewer12345]

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.

 

[GTFan]

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?

 

[athena53]

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.

 

[ziggy29]

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.