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Nearly one in three Americans have little familiarity with Obamacare, and the ramifications are playing out in the media. Since each day brings headlines highlighting Americans who are surprised by changes in their health care situation because of President Obama’s signature achievement, The Heritage Foundation compiled three Obamacare items that might surprise you:
1. Your doctor could be outside the network of your Obamacare exchange plan. This could be true even if the insurer said that physician is in its health care provider network. The California state exchange, called Covered California, has had a systemic problem with this issue. Earlier this month, the exchange pulled its physician directory for the second time because of all the errors.
Since the health plans took effect January 1, many Obamacare enrollees in California have complained that doctors won’t take their insurance, despite being listed as part of the plan’s network. Insurance expert Edmund Haislmaier, senior research fellow in Heritage’s Center for Health Policy Studies, says it’s a combination of insurers rushing to get information to the exchanges and the exchanges not updating their directories quickly enough.
Some health care providers could be negotiating with insurers over payment rates, which delays doctors from being in plan networks, Haislmaier added. “This will sort itself out over time but it’s an issue that is still playing out,” he said, advising enrollees to call their physicians first to verify participation in plans offered by the Obamacare exchanges.
2. You might get a better deal if you buy insurance outside an Obamacare exchange.Unless you live in the District of Columbia or Vermont, you can buy health insurance outside the exchanges, either through an insurance agent or directly from an insurer. The biggest disadvantage is that such health plans aren’t eligible for Obamacare’s subsidies.
But some Americans don’t qualify for Obamacare subsidies anyway, such as those making more than 400 percent of the federal poverty level (about $45,960 for an individual or $94,200 for a family of four). For them, buying an “outside” plan could be slightly cheaper.
