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Health Care Reform:

Health Insurance & Affordable Care Act

On Some Plans, Providers Are Limited


"They claim they are putting their premiums out on the street at a very low rate to make them affordable," he says. "But we can't afford to see these patients for the same amount of money that a private doctor in his office with one assistant can."

Calman accepts five plans. A handful of others wanted to pay him less than what he receives from Medicaid.

A trade association of New York doctors polled its members and found that three-fourths of them are either not participating in exchange plans or are unsure if they are.

Elisabeth Benjamin, the health exchange navigator, is also a senior policy adviser at the Community Service Society, which aids lower-income families. She says New York has done a good job generally making sure the all policies have enough in-network providers - but things are still in flux.

"It is a game of musical chairs. The providers and the health insurance companies - the music's still playing," she says. "But eventually the music will stop, and then we'll have a strong sense of who the actual provider list is."

And that will continue happening over the next few years.

Benjamin printed out a comparison chart for her client, John Batteiger, of the plans he's considering purchasing.

Batteiger, who's been uninsured since June, says he's not worried about finding a personal physician who accepts this or that plan, since he'll be starting from scratch, anyway.

But for other consumers who care about going to particular hospitals or doctors, Benjamin advises calling those offices before signing on to a plan.


Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Fri, Nov 1 2013

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