NCPA - National Center for Policy Analysis

Doctor Choice in ObamaCare? Not So Much

October 23, 2013

Premiums and deductibles may not be the only surprises awaiting Americans shopping for health insurance on the ObamaCare exchanges, says CNN Money.

  • Many insurers have opted to limit their selection of doctors in some exchange plans to keeppremiumsand other costs down.
  • And they are also excluding large academic medical centers, which are often pricier because they tackle sicker patients and more complex cases.
  • "The sticker price will be lower if the number of options are lower," says Joe Mondy, a spokesman withCigna, which is participating in five state exchanges. "The issue is how many options can you do without?"

Enrollees in the exchanges are expected to be particularly cost conscious because many of them will be lower income, says Ceci Connolly, managing director of PricewaterhouseCoopers Health Research Institute. Some 86 percent will be eligible for federal subsidies, according to the institute. Many of these new participants are currently uninsured, making it likely that they don't have strong relationships with doctors.

  • WellPoint,a BlueCross BlueShield insurer that offers policies in 14 states, is narrowing its networks in many markets after research showed consumers care more about the price than the provider.
  • In areas with a heavy concentration of doctors, WellPoint might offer ObamaCare plans with only half the number of doctors available in its off-exchange plans, says Colin Drozdowski, vice president of provider engagement and contracting.
  • But where there's less choice, the network might be only 10 percent to 20 percent smaller.

Insurers are also restricting participants' access to doctors through HMO plans that don't offer out-of-network benefits. So patients have to stick to a certain set of physicians and hospitals or foot the full bill themselves.

Source: Tami Luhby, "Doctor Choice in ObamaCare? Not So Much," CNN Money, October 14, 2013.


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