Affordable Care Act: Health Insurance Marketplace Plans and Their Provider Networks – How Do They Affect You?

Posted November 29 2014


ACA Health Insurance Plans

The open enrollment period is in effect through March 31st, 2014. MHG Insurance Brokers would like to make you aware of specific deadlines that are approaching, as well as provide you with information on a topic that has been getting a lot of attention lately – shrinking plan provider networks on the ACA health insurance marketplace.

Here are some notable dates to bear in mind:

  

  • For government approved health plans effective March 1st – enrollment deadline February 15th, 2014
  • For government approved health plans effective April 1st  – enrollment deadline March 15th, 2014
  • Final Enrollment date to obtain a healthcare plan or off the exchange – March 31st, 2014 for effective date of May 1st, 2014
If you are looking to buy health insurance, use this time to evaluate and compare the many plans available that you will be presented with. There has been attention given recently to the sizes of the provider networks that are a part of the plans offered through the health insurance marketplace. It appears that these plans’ provider networks are smaller in order for the plans to provide affordability and be able to compete with other plans offered on the exchange. The ACA doesn’t set prices for these plans or for medical services provided to the consumer, the insurance companies do. Smaller networks with fewer provider choices means smaller premiums for the consumer. In order to be more affordable, these plans exclude the most expensive providers. 

While insurance companies decide which doctors and hospitals will be a part of a network, there are also doctors who will only accept higher fees before they choose to participate in some networks. This is typical behavior within a competitive market. It is important when weighing the benefits of plans you are considering to check what provider networks your current doctors are participating in. You may wish to only consider those plans if keeping your doctors is important to you. When you find networks that your doctors participate in, call your doctors to confirm the information before selecting a plan. This extra effort will pay off, as selecting a plan that your doctor may no longer accept could be a critical mistake, as you won’t be able to change your plan again until the next open enrollment period, or a qualifying life event takes place, such as a marriage, birth or adoption of a child, or divorce. 

One comforting fact to be aware of: no matter which plan you select, the law prohibits insurance companies from requiring higher copayments or coinsurance if you get emergency care from an out-of-network hospital. If you are traveling and an unfortunate accident lands you in a hospital emergency room that is not on your provider network, you do not need to get preapproval before receiving emergency services. This applies to all plans that were created or obtained before March 23, 2010. 

 As always, MHG Insurance Brokers is here to assist you with all of your insurance needs. Our in depth and current knowledge can help you navigate through all of the information and choices you will come across when shopping for a health care plan. Call MHG Insurance Brokers today at 954-828-1819 to learn more about the new healthcare plans available, or visit MHG Insurance Brokers online at mhginsurance.com. We look forward to protecting your health!