Will my doctor be on the Obamacare plan’s network?

The recent article The Real Reason You May Not Be Able to Keep Your Doctor Under The New Healthcare Law written by Robert Laszewski and published in The Health Care Blog discusses in depth the question many people ready to enroll in new healthcare plans ask themselves: Will my doctor be on the Obamacare plan’s network?  Here is the brief synopsis of the article.

Old and New Health Insurance Markets: Change of Landscape

The old health insurance market was defined by two factors: medical underwriting and plan design. The network was relatively minor factors; most consumers assume that they will be able to use about any doctor or hospital. Under Obamacare both of these factors are gone. Insurance companies can no longer use medical underwriting and exclude people from coverage. And all health plans have to fit now four strict boxes: Bronze, Silver, Gold and Platinum. All boxes have the same benefits but different out-of-pocket costs.

With these two factors gone, how can health plans distinguish themselves on price?

Provider Networks – New Important Obamacare Plans Consideration

The study based on 13 different U.S. cities shown that:

“Typically the highest-priced hospital is paid 60% more for inpatient services than the lowest-priced hospital”. The same is true for doctors; the range of prices paid to primary care practices is typically between 85% and 135% of the Medicare fee schedule.

Naturally that with the elimination of old health insurance factors the price justification based on network become more and more important. In other words, “which doctors and hospitals a health plan picks for a plan to offer on the health insurance exchange can make a big difference in what plan charges its customers”. And you may expect that those narrow network plans will be the lowest cost plans on Exchange.

Will my doctor be on the Obamacare plan’s network? Narrow network and its consequences.

Author discusses two consequences of narrow networks:

“Some health plans will only offer narrow networks on the new health insurance exchanges”. It means that people buying those plans “will not have access to some of the most respected centers of excellence if they have a serious illness”

“These narrow network plans are almost certain to become the lowest cost plans in the exchange”. Federal insurance subsidies are based on the second lowest-cost Silver plan. Therefore “if you want a wider network plan, any cost difference for that plan becomes the responsibility of the consumer”

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