Health Insurance Exchanges: What Are You Really Buying Into?

Marisa Torrieri

health care exchangeScott Kraft, a 40-year-old marathon enthusiast, spent more than a decade covering health care policy in the Washington, D.C., area as a reporter before transplanting to Portland, Ore., a few months ago with his longtime boyfriend.

But while he knows the insides and outsides of the Affordable Care Act, and appreciates that he can get access to the same insurance as his friends without asthma (a pre-existing condition), he is having a hard time making the commitment to enroll in a plan through his state’s health care exchange website (a handful of states launched their own health care exchange websites when launched, as part of the ACA).

The problem: He doesn’t know what kind of access to doctors and primary care he’ll have whether he enrolls in a premium “platinum” plan, a “gold-level” plan, a “silver-level” plan, or a basic “bronze-level” plan.

“The X Factor has been network availability,” says Kraft, who is unable to get insurance through his domestic partner‘s employer because the two are not married. “I’m fairly new to Oregon, so I don’t have a network of doctors. I don’t have to worry about, ‘Will I lose my provider?’ But for all the information I can get on the site, I am struggling to find out, ‘What if I can’t find a plan … with a good doctor with an open panel?’”

Kraft’s anxiety about the actual “coverage” that comes with these plans—how easy it will be to find a doctor, make an appointment to be seen quickly and related needs — is at the heart of the uncertainty surrounding the enrollment in the Affordable Care Act’s health insurance exchange plans. So far, about 100,000 consumers have already enrolled.

Still, many of those who have or plan to soon enroll may be in for a shock when they realize that finding a great doctor and getting the care and services they need may not be as easy as picking a plan on a website—or as “affordable.”

According to a recent survey of more than 1,000 medical groups (representing more than 47,500 physicians) from the Medical Group Management Association, an organization that represents primary care physicians, 14% of physician practices currently say they won’t participate in the new health insurance exchange plans, while only about one in three practices say they definitely will.

Another 40% said they are still evaluating whether or not they will participate with health insurance exchange products. One of the biggest reasons doctors don’t want to participate: Financial burdens such as the pain-in-the-butt task of collecting payments from patients with high deductibles.

RELATED: What Obamacare Means for Your Health Care

Doctor interests aside, for consumers like Kraft who want to get the most for their money when it comes to affording health care, this begs a few questions: What kind of health care coverage are you actually buying into when you purchase an exchange plan? And could it change overnight?

Here’s a closer look at coverage issues, and how to figure what insurance policy makes sense for you financially.

  • Terri Hardin

    This is a very timely (or post-timely) article. Although it’s tied around the ACA, people who have insurance through their employers have to navigate these waters as well. You always have to compare plans carefully, and tailor them to your needs. What’s new is that the ACA provides a safety net for people who find themselves in a health crisis without resources.

    Advice? 1. Always get the best insurance you can afford. 2. If you are new to an area, use consumer communities like Angie’s List to help you make informed decisions.

  • kgal1298

    People forget or don’t realize they get the tax breaks which has been one of the issues with this entire roll out…an uninformed public.