ACA acceptance by doctors

[Alex The Great]

I believe it is not a secret that many doctors does not like plans offered on exchange. Are there any individual health insurance plans which has a network similar to employer provided plans? For example, when buying directly through BCBS without subsidy?
Other question I have is about Medicaid expansion. Apparently very low income is required to qualify for it. But would it have any difference in the network size, compared to ACA?
Your feedback would be appreciated!

 

[pb4uski]

I believe it is not a secret that many doctors does not like plans offered on exchange. ....

Not here... the network that I have under ACA is pretty much the same as the network that I had access to under a HDHI plan when I was working.

 

[Alex The Great]

Thanks, it sound encouraging. It looks like an opportunity. Are there anyone from California who had problems with ACA plan network size? I know Kaiser is accepted for sure, but it might not be the best option around.
Also even if in some areas this might not be a problem, is there a right way to figure out the extend of damage before getting sick and learn it hard way? Can insurance agent help with that?

 

[MRG]

My first year on ACA vs employers the same providers were in the network. Later years appeared the same.

One thing you should do before purchasing any plan is look at the in network providers.

 

[Dtail]

My first year on ACA vs employers the same providers were in the network. Later years appeared the same.

One thing you should do before purchasing any plan is look at the in network providers.

You can accomplish this aspect through the official Healthcare.gov site.

 

[Alex The Great]

Thank you. In CA, we have coveredca.com. But it is hard to learn about the network, which can change even for the same provider but different plan.

 

[aja8888]

Doctor acceptance varies greatly from state to state. And even some of those doctors on the acceptance list really won't take it. That was DD's experience in Texas.

 

[Alex The Great]

Doctor acceptance varies greatly from state to state. And even some of those doctors on the acceptance list really won't take it. That was DD's experience in Texas.

Yes this was exactly my point. I explored plans offered in my area on exchange, and they automatically include most doctors I currently use with employer sponsored plan when I select PPO plans only on marketplace. But the real story of course may be different, and there is no way to know other than calling a specific doctor and ask. And even in this case, situation may change with time.

 

[Aerides]

Yes this was exactly my point. I explored plans offered in my area on exchange, and they automatically include most doctors I currently use with employer sponsored plan when I select PPO plans only on marketplace. But the real story of course may be different, and there is no way to know other than calling a specific doctor and ask. And even in this case, situation may change with time.

In my experience it's no different on the ACA than with employer plans. Some docs take some, not others, and change throughout the year, stop taking new patients, etc.

And there's no difference between plans if you buy them off the exchange vs. direct - it's the same plan. If it's not an employer plan it's an ACA plan (except for some short term 11 month type things). Your provider doesn't know if you're getting subsidies, and it's still ACA plan even if you're paying in full.

My Florida Blue plan is accepted pretty widely here, but not by everyone. Much like the Aetna plan I had while still working. Since you're in CA, your concerns re acceptance are probably less of a worry than some states.

 

[rodi]

Thanks, it sound encouraging. It looks like an opportunity. Are there anyone from California who had problems with ACA plan network size? I know Kaiser is accepted for sure, but it might not be the best option around.
Also even if in some areas this might not be a problem, is there a right way to figure out the extend of damage before getting sick and learn it hard way? Can insurance agent help with that?

I was on Kaiser before ACA - and still on Kaiser now. Kaiser's network is their same closed network. My employer plan was a copay plan with nice low copays... Nothing super comparable under CoveredCA (the ACA exchange for California). I chose a high deductible, HSA compatible plan under the ACA... so I have a lot more out of pocket per visit. Kids and I continue to use Kaiser.

My husband is not a fan of Kaiser and was on a Sharp HDHP w/HSA when we switched to ACA. Now he's on Medicare with a Fplus plan... same doctor under both plans. Medicare with supplement is much less out of pocket. An advantage to getting older. Sharp is a San Diego specific insurer and hospital network.

Somewhere in the CoveredCA website you can look up if your current doctor is available under the plan.

 

[Accidental Retiree]

Back in 2014, before visiting a dermatologist in our new location, I checked the Anthem website for a name.

I got one, and I called to see if they took my Anthem bronze plan. Yes.

When I arrived and gave them my card, they said they did not take the Plan and said I should have specified it was a Covered CA Anthem Bronze plan.

I left and found another doctor.

The plans had the same name, but doctors did not participate in *Covered CA* plans. There was some discussion around this issue back then.

 

[Sunset]

Actually, it's no secret doctors only take some plans and not others. It's been like this before ACA. It's like this with employer plans, even the same employer offering different (bronze , silver, gold, etc) plans might have a doctor take 1 plan , but not the others.
Totally confusing and annoying.

 

[SecondCor521]

I've always been able to go from my state's insurance marketplace website to an insurer plan to the doctor / facility in-network search feature rather easily, and it's always been accurate for us, although we don't go to many different doctors - maybe four or five total since being on ACA plans for the past 4 years.

I know there are occasionally network changes or discrepancies where a provider is shown as in-network but in fact is not. I don't think this problem is unique to ACA plans; I think it happens with employer plans too. I chalk it up to lots of providers and frequent changes and occasional human error.

If one goes to an in-network provider and discovers they are out-of-network, I think it is possible to appeal to the insurance company based on the discrepancy and they might cover the visit as in-network as a one-time courtesy.

 

[swakyaby]

You’re right to be concerned about physician acceptance of employer-sponsored insurance vs ACA insurance vs Medicaid. There are quite a few physicians in CA who are in-network with employer sponsored Anthem Blue Cross plans but out-of-network for covered California blue cross plans. When I contacted my GI doctor’s office for an appointment in 2017, the receptionist practically hissed “We don’t accept Covered California!” when I provided my Blue Shield information over the phone. She changed her tune when I assured her that it was the same plan I had from my employer, except it was now COBRA.

Mistakes and misunderstandings do occur. When I enrolled in a Healthnet ppo plan this year, I first contacted my primary care Dr’s office to confirm they were in-network. No less than 2 employees at the Dr’s office and a Covered California representative assured me that the Dr was in-network. But it turned out not to be true and Healthnet billed me for the entire out-of network cost. Healthnet customer service said I should have contacted the insurance company directly to confirm whether a provider was in-network.

Finding physicians who accept Medicaid is even more difficult than finding physicians who accept Covered California plans. They complain that Medicaid pays so little for services that it costs them money to provide care. So my advice is to contact the insurance company directly to find out if certain physicians are in-network before you sign up for the plan.

 

[jim584672]

Most Medicaid plans are Managed Care HMO plans with a set network of doctors. You can compare plans and look at both networks between ACA and Medicaid. If you are lucky you will find your doctor in the network. My work plan, ACA plan, and Medicaid plan had my doctors in them.

 

[ShokWaveRider]

I believe it is not a secret that many doctors does not like plans offered on exchange.

Another misnomer, it probably depends where you live, plenty here. In fact we trip over doctors who take everything from Medicare to any ACA plan.

 

[RetiredAndLovingIt]

I'm in So Cal. The first year I picked a PP0 BCBS plan that matched my ex employers plan and deductible. I entered my doctors and local hospital names in my search criteria when choosing a plan and also verified with my doctor and labs that it would be accepted. Nothing changed for me at all. This year I picked Kaiser high deductable HSA plan banking on continued good health and it's great so far, they are definitely far more efficient than my doctors office was. Premiums are $1 monthly so I'm saving a lot for my out of pocket expenses which are billed to me at the lower negotiated rate.

 

[candrew]

the network that I have under ACA is pretty much the same as the network that I had access to under a HDHI plan when I was working.

Same here. In fact, I now have access to a wider network of providers with ACA coverage than I did through my employer sponsored healthcare plan.

 

[Rianne]

In my experience it's no different on the ACA than with employer plans. Some docs take some, not others, and change throughout the year, stop taking new patients, etc.

And there's no difference between plans if you buy them off the exchange vs. direct - it's the same plan. If it's not an employer plan it's an ACA plan (except for some short term 11 month type things). Your provider doesn't know if you're getting subsidies, and it's still ACA plan even if you're paying in full.

We're very happy with our ACA plan. The HD HSA plan with low monthly fee allows us to save quite a bit. And if we maxed the deductible $6000/individual $13000/family, that's still less than if we had no subsidies. A no subsidy bronze plan is $24,000/yr., $2000/month premium. Add the deductible on top of that. When we contribute the $8000 to the HSA that comes off the MAGI.

I always thought providers knew we were getting subsidies. Thought it was coded as such.

 

[Accidental Retiree]

We're very happy with our ACA plan. The HD HSA plan with low monthly fee allows us to save quite a bit. And if we maxed the deductible $6000/individual $13000/family, that's still less than if we had no subsidies. A no subsidy bronze plan is $24,000/yr., $2000/month premium. Add the deductible on top of that. When we contribute the $8000 to the HSA that comes off the MAGI.

I always thought providers knew we were getting subsidies. Thought it was coded as such.

It’s right on the insurance card, however it is coded.

 

[Freedom56]

We buy an off-exchange plan (Circle EPO) directly from OSCAR health that covers most major providers including UCLA Health where our doctors are. We don't have any subsidies so we have been buying from insurance companies directly since early retirement. BCBS is another option, however we had BCBS one year and had many headaches getting them to pay for preventive care. I was tired of dealing with them so we switched to OSCAR.

 

[Alex The Great]

Thanks to everyone for very useful info. It looks like acceptance indeed depend on location. May be doctors has a better choice where many employers are located. Looks like Florida is a better place for RE to this extend.

 

[Sue J]

When we were using ACA I had to be very careful when selecting a plan. Similar sounding names like ""YourInsure Select" and "YourInsure Connect" where the deductibles and copays were the same and the only difference was one was a much narrower network of providers.

Also, some providers would accept "YourInsure" employer policies but specifically excluded the ACA (Marketplace) policies.

In my experience my doctor's office knew that I had an ACA policy but they would not have known if I was getting a subsidy or how much.