Mandatory health insurance coverage under the Affordable Care Act (ACA) for most Americans starting on January 1, 2014 will cause a flood into the market of previously-uninsured individuals and those needing to get new coverage. Coupled with the fact that insurance plans will be required to cover a comprehensive list of essential health benefits, insurance companies and government officials are trying to find ways to hold down medical costs.
Renegotiating reimbursement rates with health care providers is one avenue by which insurance carriers may be able to do this. Some providers are willing to accept a lower reimbursement rate in exchange for a larger volume of patients to treat.
But some are not.
This has become apparent in California, where preliminary information about carriers and plans that will be offered in the state-run exchange was recently made public. It turns out that the premiums for California’s exchange plans are expected to be lower than first anticipated, but, the medical providers that have agreed to treat policyholders will be limited, with some doctors and hospitals not participating under any plan sold on the exchange.
Some industry experts believe that California is a model — an experiment, if you will — of how things will shake out across the United States.
We will be watching the developments locally here in Virginia, Maryland, the District of Columbia, and surrounding states as the exchanges in these areas get closer to implementation.
UPDATE September, 2013. According to a recent article in the New York Times, California’s experience was not a fluke. Provider networks are expected to shrink, leaving Americans with fewer providers from which to choose.
The bottom line is this:
When selecting a plan this fall, consumers must be super careful to be sure their trusted physician or hospital participates. Even going with a mainline carrier like Blue Cross, Aetna, United, etc. will not necessarily guarantee access to the complete current national networks.
Give us a call so we can help you choose the right plan for you!